CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Supports the Corporate Responsibility Program (CRP) by developing, implementing, and maintaining an effective and comprehensive compliance monitoring program. Conducts and facilitates monitoring activities across CommonSpirit Health and analyzes outcomes, communicates findings, and ensures follow-up on action plans as appropriate. Operates in an independent and objective manner and maintains a high level of competency related to compliance with State and Federal laws and regulations.
• This is a remote opportunity.
Essential Key Job Responsibilities:
• Conducts reviews to include physician payments, business associate agreements, lease agreements, etc.
• Participates in the Physician Transaction contracting process
• Acts as a contracts platform administrator
• Supports the development, implementation, maintenance, completion and reporting of the annual CRP Monitoring Plan.
• Performs compliance monitoring as required to identify education opportunities and areas of potential risk. Monitoring may include but is not limited to coding, medical documentation, privacy and general CRP compliance.
• Determines monitoring procedures to be used, including the use of computer-assisted audit techniques.
• Obtains, analyzes, and appraises evidentiary information as a basis for determining the adequacy and effectiveness of internal compliance controls.
• Provides education to departments regarding audit findings, reimbursement impact, identified compliance issues and risk mitigation, and recommends changes to improve processes, strengthen controls, and promote compliance.
• Prepares and presents monitoring reports and works with management to develop corrective action plans. Keeps management informed of any significant findings detected during an audit or monitoring project.
• In collaboration with Corporate Responsibility Officers, assists with tracking follow up with operations on development, implementation and completion of action plans.
• Maintains monitoring statistics for tracking and trending purposes.
Benefits Include: Benefits include Medical, Dental, Vision, Paid Time Off, Holidays, Retirement Program, Disability Plans, Tuition Reimbursement, Adoption Assistance, Employee Assistance Program (EAP), Discount Programs, Life Insurance Plans, Worker Compensation, Dress for Your Day Policy, Voluntary Benefits.
Compensation Range: $33.68 to $43.78 hourly rates, annualized.
• Bachelor’s degree in accounting, health information management, nursing, business or related health care field preferred – experience in lieu of degree may be considered.
• Minimum 3 years of experience in contracts auditing and monitoring
• Minimum of three (3) years of experience in health care compliance, internal audit, coding, billing, finance or other related field.
• One or more of the following preferred upon hire or required within first year of employment: Certified in HC Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Health Professional (CHP), Certified Coding Specialist - Physician-based (CCS-P), Certified Coding Specialist (CCS), Certified Prof. Coder through AAPC (CPC), Certified Public Accountant (CPA), Registered Nurse (RN), Bachelors of Science in Nursing (BSN) or paralegal
• Ability to work independently to manage multiple projects simultaneously
• Knowledge of federal and state laws and regulations regarding physician self-referral and fraud and abuse
• In depth knowledge of healthcare regulations and guidance relative to assigned subject matter area (acute, physician enterprise, post-acute, physician contracting, etc.)
• Ability to research regulations and guidance for interpretive purposes
• Ability to analyze data, identify and summarize trends