HCS Compliance Analyst II - Hospital Compliance

HCS Compliance Analyst II - Hospital Compliance

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

The HCS Compliance Analyst II will primarily support Hospital Compliance and may have responsibilities across the Compliance and Privacy Operations including Physician Compliance as needed.

Under the supervision and direction of Compliance Program leadership, the HCS Compliance Analyst II implements the essential elements of UNC Health's systemwide Compliance Program, such as conducting audits, monitoring ongoing risks to the organization, training and educating teammates, completing investigations of potential misconduct, and providing such other professional services as directed. Utilizing advanced analysis techniques, the HCS Compliance Analyst II completes assigned tasks independently and also collaborates with teammates across UNC Health Care as needed to promote compliance with legal and regulatory requirements, as well as UNC Health policies and procedures. In addition, the HCS Compliance Analyst II serves as a resource to physicians, coders, reimbursement analysts, and other teammates across UNC Health.

Responsibilities:

1. Auditing and Monitoring: Assists in conducting the annual systemwide Compliance Program risk assessment and in preparing the audit and monitoring work plan for each fiscal year. Completes individual audit and monitoring projects outlined in the Compliance Program work plan. Collaborates with teammates from across UNC Health in order to complete individual projects. Obtains and analyzes patient and business specific data in order to evaluate specific risk areas under review. Performs data collection and analysis. Makes recommendations for performance improvement consistent with applicable policies and legal/regulatory requirements. Analyzes audit findings and reports/tracks results for one-on-one or group feedback. Provides one-on-one or group education. Documents findings in accordance with department standards, communicates findings as directed by leadership, and provides an analysis of findings with recommendations.

2. Research and Analysis: Maintains current and up-to-date understanding of relevant laws, regulations, policies, procedures, standards, coding guidelines, and CMS guidance. Identifies and analyzes areas of weakness, performs root cause analyses, and formulates recommendations that enhance operations and compliance. Researches and gathers all relevant materials for risk area under review, including but not limited to regulations, policies, procedures, coding guidelines, and external laws/regulations. Conducts interviews with internal subject matter experts in order to understand operational, administrative, and/or clinical workflows in order to thoroughly assess compliance issues and risk.

3. Investigations: Conducts investigations of actual or potential violations of relevant laws, regulations, and/or UNC Health policies. Conducts EthicsPoint investigations as assigned by Compliance Program leadership. Documents findings in accordance with department standards, communicates findings as directed by leadership, and provides an analysis of findings with recommendations. Works with operational and clinical leaders to implement corrective action plans.

4. Building Relationships: Develops productive working relationships with UNC Health teammates and external stakeholders. Communicates openly and effectively with UNC Health teammates and external stakeholders. Identifies barriers to completing Compliance Program objectives and develops strategies for resolving those challenges. Serves as a resource to physicians, coders, reimbursement analysts, and other teammates. Responds to inquiries about standards and best practices for coding, billing, documentation, and other risk areas.

5. Professional Development: Intermediate to advanced understanding of healthcare reimbursement, health system operations, medical staff standards, coding, billing, and documentation, along with experience using electronic health records. Intermediate to advanced presentation skills. Ability to translate technical coding, billing, and regulatory information and knowledge to non-technical users. Advanced organizational skills with the ability to manage multiple projects and multiple deadlines in a positive manner. Advanced proficiency with software applications such as Microsoft 365 with the ability to use graphs, spreadsheets, pivot tables, formulas, Visio flow charts, dashboards, and other analytic tools. Advanced proficiency with applications required for area of expertise, data extraction, and data analysis. Intermediate to advanced data analysis and critical thinking skills. Ability to organize, analyze and interpret data and evidence, communicate findings and make recommendations.

6. Special Projects: Performs special projects as requested or assigned by Compliance Program leadership. Assists with RAC audits and review of other external audit requests. Conducts and/or facilitates professional meetings where information is shared with operational departments concerning new regulations, billing and other compliance activities or standards. Assists with the development and delivery of appropriate compliance training and education across UNC Health. Prepares policies, procedures, tip sheets, and other resources for UNC Health teammates.

Education Requirements: Bachelor's degree in Accounting, Business Administration, Health Administration, Nursing or related field. Licensure/Certification Requirements: Relevant professional credential(s) or coding certification (e.g., CPC, CCS-P, RHIA, etc.) within eighteen (18) months from date of hire. Professional Experience Requirements: Five (5) years of health care compliance, revenue cycle, nursing or other directly related experience required. Knowledge/Skills/and Abilities Requirements: Excellent communication skills and abilities with regard to active listening, interpreting complex information, and presenting materials. Able to clearly express thoughts and ideas and to effectively transfer knowledge to others. Must be able to interview staff to understand operational processes and areas of concern. Written communication is clear, concise and professional. Demonstrates a positive attitude and ability to work with groups of teammates. Maintains appropriate professional conduct, appearance and language. Is tactful and respectful in communication. Ability to lead others and serve as a mentor to peers.