Compliance Analyst

Compliance Analyst

Job Summary

*** This is a hybrid role and requires 3 days in office in Mishawaka, Indiana ***

The Compliance Analyst is a member of the compliance team and works closely with outside entities and other team members throughout the organization. The primary duties and responsibilities of the job include management and processing of medical records, external payor audits, internal billing audit reviews, and tracking of HIPAA Privacy violations. This role is responsible for processing of records requests received, including external payor audits, processing learner release of information requests while assuring compliance with state, federal and HIPAA regulations. A large portion of the Compliance Analysts job role will be conducting Internal Audits of the Center learner documents and billing session notes. Following review and identification of any noted areas of non-compliance the Compliance Analyst would communicate findings and work with the center to develop an action plan to correct the deficient practice and minimize future risk. The Compliance Analyst will understand and fully support the mission, vision, and value statements of Lighthouse Autism Center.

This position is accountable for:

• Medical Records Requests, which consist of:
• Medicaid/Disability Requests
• Legal Record Requests
• DHS, CPS, HHS, Records Requests
• School Requests
• Claim Processing Records Requests
• Other Provider Requests
• External Payor Audit Records Requests
• Gathering, combining and review of documents prior to submittal
• Filing and logging all external audits
• Internal Billing Audits
• Direct Communication with the center level leaders providing audit findings
• Completion of the Billing Audit Report Card
• Corrective Action initiative identified
• Center level follow up as needed
• Working with training team, on further training as required for the center staff
• Documenting findings and action taken to resolve compliance concerns
• Other administrative duties as assigned

Essential Duties and Responsibilities

• Verifies legitimacy, accuracy and authority of requests received and then processes and invoices as appropriate.
• Abide by, adhere to, and conform to all applicable organizational, local, state, federal regulations including HIPAA regulations.
• Tracking HIPAA Violations and working with the Director of Compliance in reporting required HIPAA Violations.
• Interacting with senior leaders, including the executive leadership team, with professionalism and competence is expected for this role.
• Processes records and audit requests received, from start to finish, assuring deadlines are met.
• Communicate with external auditors as required.
• Logs all types of records, audits and other medical records requests received.
• Completes Internal Billing Audits for all centers in the allotted time frame.
• Provides guidance on areas that center team members may need more education and training after review of documentation.
• Working with the Director of Compliance on internal investigations, regarding compliance violations and concerns.
• Being available to team members throughout the company who may have general compliance related questions.

Expected Areas of Competence

• Requires excellent organizational skills and ability to pay attention to details.
• Requires excellent communication skills, both verbal and written, as every person you interact with is considered a stakeholder.
• Ability to work independently.
• Ability to prioritize.
• Ability to respond effectively and meet time deadlines while managing multiple audits and responsibilities.
• Basic keyboarding skills.
• Demonstrated proficiency and understanding of database software including database updates, maintenance, and report generation.
• Must be computer literate in Microsoft Office suite.
• Effective and professional telephone skills.
• Strong level of confidentiality due to sensitivity of materials and information handled.

Physical Requirements

While performing the duties of this job, the employee is regularly required to sit for prolonged periods of time. The team member is occasionally required to stand, walk, and use hands to operate a computer keyboard. The team member may occasionally lift and or move up to 25 pounds. Vision requirements include close vision, distance vision, depth perception and the ability to adjust focus.

Education/Experience Requirements

• Bachelor’s Degree Required
• Experience in healthcare compliance or auditing work preferred.
• Healthcare experience preferred.