Description

PeaceHealth is seeking a full time Healthcare Compliance Specialist - Organizational Integrity. This remote role requires the incumbent to reside in OR, WA, AK or TX by date of hire.

Job Summary

Supports the Manager, Healthcare Compliance in developing, implementing, and maintaining the Healthcare Compliance Program for PeaceHealth. Assists with conducting and coordinating compliance investigations, annual work plan, and monitoring regulatory compliance across PeaceHealth systems. Responsible for identifying, assessing, and recommending corrective actions (including analyzing root causes and controls) regarding process-related issues in support of operational compliance with state and federal laws and regulations.Contributes to the development and maintenance of a compliance program in accordance with the Department of Health and Human Services, Office of Inspector General (OIG), state and local regulations. Assists with Implementing and maintaining an effective organizational compliance program based upon the OIG's seven (7) elements of an effective compliance program and PeaceHealth policies.

Essential Functions

• Assists in developing, implementing, and maintaining the Healthcare Compliance Program.

• Responds, identifies, and investigates alleged violations of rules, regulations, policies, and procedures related to healthcare compliance through initiating and conducting compliance investigations and remediations as applicable.

• Communicates outcomes of investigations to appropriate staff and department leadership. Remediates compliance issues by providing education, making recommendations to leadership, implementing corrective actions, ensuring timely completion of remediation as applicable. Conducts follow-up examinations to ensure effectiveness of remediation efforts.

• Supports the overall administration of the Healthcare Compliance Program, including responding to inquiries and assisting with response tracking.

• Acts as a liaison for the Healthcare Compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions. Research laws, rules, and regulations, obtain appropriate legal advice and assist with implementing action plans and process improvements.

• Assists with developing and providing caregiver training on compliance policies, practices, and reporting.

• Participates in the Healthcare Compliance Program planning, including annual compliance risk assessment.

• Assists the Program Manager, Government Billing Audit with the system-wide program for responding to government billing audits and appeals, including, but not limited to: RAC, MAC, PERM, CERT, ZPIC, SMRC, QIO, MAC TPE, state Medicaid audits, and others.

• Represents and coordinates various committees and task forces related to Healthcare Compliance, including leading compliance projects, and conducting investigations.

• Performs other duties as assigned.

Qualifications

Education

• Bachelor's Degree or equivalent knowledge and skills obtained through a combination of education, training and experience.

Experience

• A minimum of five years of compliance experience (within compliance or clinical departments) and/or experience in one or more of the following disciplines: Coding in a healthcare setting; Medical records management; Clinical setting; Education in the healthcare setting.

Credentials

• Certified in Healthcare Compliance required within 3 years.

Skills

• Strong interpersonal skills and analytical skills.

• Strong writing and verbal communication abilities facilitate effective, concise, professional, and nonjudgmental discussions and reporting with PeaceHealth caregivers, clinicians, and leadership.

• Strong presentation skills and ability to interact with all levels of leadership across the PeaceHealth continuum.

• Knowledge of Medicare and Medicaid documentation and coding rules and guidelines.

• Knowledge of healthcare compliance audit methodologies, principles, and techniques.

• Ability to process large quantities of detailed information with high levels of accuracy.

• Ability to prioritize own activities in accordance with work demands. Remains flexible and ready to assume additional responsibilities as needed.

• Ability to research and analyze information and provide alternative solutions for problem solving.

• Ability to maintain confidentiality and handle sensitive information with judgment and discretion.

• Advanced skills in all MS Office applications (Word, Excel, Outlook, PowerPoint).

Department / Location Specific Notes

May need to travel to off-site PeaceHealth locations as necessary.

Working Conditions

• Consistently operates computer and other office equipment.

• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.

• Sedentary work.

• Predominantly operates in an office environment.

• Some time spent on site in medical/hospital setting.

• Ability to communicate and exchange accurate information.

• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

The general salary range for this job opening at PeaceHealth is $36.55 – $54.83. The actual hiring rate is dependent upon several factors, including but not limited to, the job/position responsibilities, location, terms of the applicable collective bargaining agreement, education, training, work experience, seniority, work performance, etc.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility (https://www.thecaregiver.org/wp-content/uploads/2017/05/PeaceHealth-Statement-of-Commitment-to-Diversity-and-Inclusion-vFINAL.pdf) .

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.

PeaceHealth requires a completed Primary Vaccine Series (e.g., 2 dose monovalent Pfizer, Moderna or Novavax series or 1 dose J&J vaccine series) or be Up to Date (receiving the most recent Pfizer/Moderna bivalent vaccine/booster) for COVID-19 vaccination prior to their start date. PeaceHealth has a medical and religious exemption request process for those that are unable to receive the COVID-19 primary vaccine series due to medical/religious reasons. For caregivers that will be working in Oregon there is a personal vaccine exemption form that may be requested.

REQNUMBER: 83883