Senior Financial Compliance Analyst

Job Summary

Responsible for implementing and maintaining program standards and work plans for assigned financial compliance program. May assist leadership or lead in development of new program or standard work opportunities. Leads more complex compliance audits and investigations ensuring complete resolution. Supports the management of compliance standards laws rules and regulations. Provides advice guidance and recommendations to minimize risk. Identifies root causes trends/themes and assures plans and standards are in place including development education and implementation of related procedures and policies. Maintains expert knowledge in program focused area(s) including compliance policies procedures issues and industry trends. Handles the more complex level of investigations inquiries research and projects. Acts as a mentor to less experienced compliance team members.

Essential Functions

• Leads complex audits and investigations of compliance help line calls or other compliance contacts or reports at the direction of management and works with compliance leadership to determine the appropriate handling of such issues. Performs necessary research often using specialized expertise documents findings and follows up with applicable parties through complete resolution. Collects collates and monitors audits data and activities to assure accuracy and to prevent detect and correct noncompliance illegal activities and potential or actual fraud waste or abuse. Works with outside consultants or external regulatory agencies performing audits as necessary under the direction of CCO director and/or manager. From time to time performs investigations at the direction of legal counsel and works with legal counsel during such investigation to provide guidance recommendations and other assistance as requested by legal counsel. In such cases the employee will report directly to legal counsel as opposed to employees upline leadership and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection.

• Prepares enters maintains and reconciles data in the accounts payable system. Assists in training new team members. Provides guidance and direction to less experienced Compliance professionals.

• Assists in the risk assessment and annual work plan activities. Assumes accountability for the implementation of the work plans ensuring achievement of measurable goals objectives and corrective action plans for assigned program area. Assists the manager and program lead in the development of standard work for auditing investigations and corrective action and other departmental policies and procedures specific to assigned program area. Provides guidance to all compliance professionals and other key stakeholders on these processes. Uses riskbased methodologies tools (CRA) and historical/current trends to assist in risk assessment processes.

• On a continuous basis exercises administrative judgment and assumes responsibility for decisions consequences and results having an impact on people costs and quality of service. Assists with the development implementation and maintenance of process improvement including departmental and/or organizational policies procedures and methodologies assuring compliance with laws and regulations while using accumulated data. Reviews and monitors adherence to documented plans and programs including the Code of Excellence.

• Receives consultations and conducts analysis. Provides recommendation(s) to Compliance Officers and Relationship Management Teams. Collaborates with Compliance Relationship Management Teams operational and other areas in investigations (such as HR) and to implement ongoing risk identification and mitigation measures. Proactively consults with Compliance Relationship Management Teams operational areas and leadership through both formal (meetings education) and informal means. Plans coordinates and executes effective monitoring and auditing plans to reduce noncompliance.

• Maintains knowledge of complex laws and regulations impacting healthcare and health insurance delivery and reimbursement. Applies laws and regulations in daily situations while educating others through various means including formal training and annual compliance related education programs. Performs related assessments to assure compliance to laws regulations and policies and procedures.

• Performs/leads/assists with more complex routine and forcause financial compliance audits. Evaluates the accuracy of the regulatory standards ICD/CPT/HCPCS and other partypayor requirements. Verifies adequacy of documentation in support of services billed including medical necessity and compliance with other documentation coding and billing standards.

• Creates clear and accurate audit findings and recommendations in written audit reports that will be used for advising and educating coders/revenue cycle operations providers operational leaders and other key stakeholders throughout the system. Able to maintain productivity standards. Maintains electronic record of audits issues and investigations utilizing department tools and systems.

• Manages a variety of projects related to regulatory financial compliance. Identifies best practices and research and evaluates its implementation within our organization. Develops recommendations and action plans. Maintains attention to detail documents details appropriately and effectively articulates recommendations.

Qualifications

Required

• Bachelors Degree Business health care operations nursing or other related area or equivalent

• 5 years of relevant experience Progressively responsible related work experience

• Health care operations auditing and or compliance

• Compliance auditor nurse auditor or other audit function

• One of the following Certifications upon hire

  • ICD 9 or ICD 10 and CPT 4 coding or medical record audit and review

  • CRT Professional Coder AAPC American Academy of Professional Coders

  • CRT Coding Specialist CCS AHIMA American Health Information Management Association

  • CRT Coding Specialist Certified Physician AHIMA American Health Information Management Association

  • CRT Registered Health Information Administrator RHIA AHIMA American Health Information Management Association

  • CRT Registered Health Information Technician RHIT AHIMA American Health Information Management Association

  • CRTHealthcare Research Compliance Certified CHRC HCCA Health Care Compliance Association

Preferred

• Masters Degree Business health care operations nursing or other related area; or equivalent

• Experience in the legal or regulatory field; healthcare focus desirable

• Experience leading projects program development and implementation

• Experience educating clinical and nonclinical staff including Medical Staff and midlevel providers

• Experience conducting investigations performing interviews and summarizing results and findings

• CRT Healthcare Compliance Certified CHC HCCA Health Care Compliance Association

About Corewell Health

As a team member at Corewell Health you will play an essential role in delivering personalized health care to our patients members and our communities. We are committed to cultivating and investing in YOU. Our topnotch teams are comprised of collaborators leaders and innovators that continue to build on one shared mission statement to improve health instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.

• Ondemand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!

• Optional identity theft protection home and auto insurance pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

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