Job Functions, Duties, Responsibilities and Position Qualifications :
Position Summary :
Senior Compliance Audit Specialist reports to the VP of Compliance and will assist with and support the compliance program activities of Sonic Healthcare USA, WSW Division . The Compliance Audit Specialist will support the compliance department through auditing / monitoring, planning, education, assessment, and other compliance program functions including any existing compliance activities, with a particular focus on clinical / billing compliance and data analytics. They will also assist with such activities as policy and procedure development and maintenance, hotline monitoring and compliance complaint investigations, and Compliance and HIPAA training throughout the company.
Principal Responsibilities :
Perform annual compliance department risk assessment to develop annual department work plan
Design data tracking systems to detect, monitor, audit and track data to aid in identifying risk areas and correct non-compliances and monitor compliant solutionsPrepare compliance audit data by compiling and analyzing internal and external dataManage audits of federal and state exclusion sanctions listsMonitor annual and new hire compliance and HIPAA trainingReview and audit revenue billing cycle functions including but not limited to, ABNs, standing orders, charge master, and denialsAudit findings, communicate to and recommend corrective strategiesEstablish and refine, as needed, systems to effectively audit and monitor WSW Division compliance policies.Billing ComplianceBuild regularly scheduled audit mechanisms in the XiFin environment
Manage necessary data reports to support investigationsReview CCI edits, MUEs and LCD / NCDs that apply to WSW Billing regularlyManage Better Business Bureau Billing complaintsAct as compliance liaison between XiFin and WSW divisionDevelop, organize and maintain WSW division Billing policies and procedureCompliance Inspections of WSW laboratories and phlebotomy locationsUse established inspection tools to identify non-compliances and prepare reports
Provide guidance for corrective action, track completion and monitor success.Participate in employee Compliance and HIPAA educationOther compliance department responsibilitiesCommunicate, promote and exemplify the Sonic Values, Compliance Plan and Standard of Conduct to employees in a useful and understandable format
Provide guidance about regulations affecting laboratories to staffRemain current with all applicable laws, rules and regulationsContinuous self-reeducation regarding current and updated regulations using sources which include Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Department of Insurance and local carriers in each state.Participate in compliance updates and education at manager meetings, phlebotomy meetings, new sales training, QI Ops calls, etc.Medicare and Medicaid EnrollmentEducation :
Bachelor’s Degree; preferred concentrations : Chemistry, Biology or Medical Technician, Healthcare Compliance, Health Sciences, Healthcare Data Science, and Healthcare Administration.Certification in Healthcare Compliance and / or Certification in Medical Coding and BillingExperience :
Minimum of three years medical billing experience, emphasis on laboratory billingMinimum of three years corporate compliance in the healthcare sectorMinimum of three years in laboratory training and / or experience in a medical laboratoryExperience with XiFin, FIN, Misys software systemsSkills :
Good knowledge of healthcare fraud, waste and abuse regulations specific to laboratory complianceGood knowledge of Medicare laws, billing regulations, CCI edits, MUEs, LCDs / NCDsGood knowledge of Laboratory billing in terms of Managed Care, Capitation, private and government payorsScope and Root cause analysis and Corrective ActionAuditing and monitoring to proactively detect issues and mitigate riskHighly developed analytical skills for both qualitative and quantitative dataAbility to plan and lead projects following tight deadlinesDemonstrates a high-level of attention to detail and accuracyExcellent communication skills - strong verbal and written skillsAbility to exercise initiative, discretion, and judgementAbility to provide sound advice and guidance to managers and employees in supporting governance and compliance mattersTravel :
Expected Travel - one week a monthScheduled Weekly Hours :
Work Shift :
Job Category :
Administration
Company :
Clinical Pathology Laboratories, Inc.
Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
