Compliance Analyst

This is a hybrid position. The onsite requirement is 2 days per week but can fluctuate based on meetings, site visits, or compliance needs.

Job Summary

Assists with management of compliance program standards and work plans for designated financial compliance program. Supports the resolution of compliance investigations and follows up with various parties to assure its 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 thorough knowledge in program focus area(s), including compliance policies, procedures, risk areas, and industry trends. May support delegated investigations, inquiries, research and projects.

Essential Functions

• Supports audits and investigations of compliance help line calls, employee complaints, or other compliance contacts or reports; performs necessary research, documents findings, and follows up with applicable parties through complete resolution. Collects, collates, monitors and audits data and activities to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse. Works with outside consultants or external regulatory agencies in performing audits as necessary at the direction of management. From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of 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 employee’s up-line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection.
• Assists in the risk assessment and annual work plan activities. Assists in 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 risk-based methodologies, tools (CRA), and historical/current trends to assist in risk assessment processes.
• 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.
• 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 non-compliance.
• Maintains knowledge of laws and regulations impacting health care 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. Performs or supports the performance of related assessments to assure compliance to laws, regulations and policies and procedures.
• Performs/leads/assists with complex, routine and for-cause financial compliance audits. Evaluates the accuracy of the regulatory standards, ICD/CPT/HCPCS and other party-payor 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.
• Maintains, updates and distributes effective, accurate, timely reporting systems. Reports results of auditing activities to the Compliance Officer, Relationship Management Teams, operational areas, and appropriate compliance committee(s). Maintains electronic records of audits, issues and investigations per departmental standards. Assists in a variety of projects related to legal, regulatory, compliance, and/or privacy. Identifies best practices and research and evaluates its implementation within our organization. Develops recommendations and action plans. Maintains attention to detail, documents detailed appropriately, and effectively articulates recommendations and outcomes both verbally and in writing in both small and large group forums.

Qualifications

Required

• Bachelor's Degree or equivalent in business, health care operations, nursing or other related area, or equivalent combination of education and experience
• 2 years of relevant skills, knowledge, abilities typically gained through related experience; health care operations, coding, billing, auditing and/or compliance experience
• CRT-Professional Coder - AAPC American Academy of Professional Coders upon hire required Or
• CRT-Registered Health Information Technician (RHIT) - AHIMA American Health Information Management Association upon hire required Or
• CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association upon hire required Or
• CRT-Coding Specialist, Certified-Physician Based (CCS-P) - AHIMA American Health Information Management Association upon hire required Or
• CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association upon hire

Preferred

• 2 years of relevant experience:
  • Legal or regulatory field; health care focus desirable
  • Compliance auditor, nurse auditor, or other audit function
  • Project management/program development and implementation
  • ICD-9 or ICD-10 and CPT 4 coding or medical record audit and review (facility and/or professional)
  • Education of clinical and non-clinical staff including Medical Staff and mid-level providers
  • Conducting investigations, performing interviews and summarizing results and findings
• CRT-Healthcare Research Compliance, Certified (CHRC) - CCB Compliance Certified Board Or
• CRT-Healthcare Research Compliance, Certified (CHRC) - 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 top-notch 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.

• On-demand 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

Primary Location

SITE - Corewell Health Place - 100 Corewell Drive NW - Grand Rapids

Department Name

System Compliance

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. - 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.