Delphi Health Group

  • Compliance Specialist

    Job Locations US-FL-Ft. Lauderdale
    Posted Date 1 month ago(1 month ago)
    ID
    2018-1309
    # of Openings
    2
    Category
    Compliance
  • Overview

    The Compliance Specialist assists the Director of Compliance with the administration of the organization's Compliance Program, policies and practices.  Supports a culture of compliance in the conduct of health care operations regarding the integrity of billing, documentation, conflict of interest and patient privacy.  The Compliance Specialist monitors and reports results of the compliance and ethics efforts of the Compliance Department and performs objectives of an effective compliance program once approved and/or reviewed by the Director of Compliance.  The Compliance Specialist will assist the Director of Compliance with other aspects/projects/tasks/reviews of the Compliance Program to assure compliance with licensure, accreditation and other applicable state and federal regulations.

    Responsibilities

    Responsibilities

     

    • Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
    • Maintains current knowledge of laws and regulations, keeping abreast of recent and/or pending changes.
    • Facilitates review of payor audits.
    • Collaborates with all departments to direct compliance issues to appropriate existing channels for investigation and resolution.
    • Supports the Director of Compliance in responding to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct.
    • Supports the department in annual internal monitoring program to assess at least three high risk areas to monitors the performance and related activities on a continuing basis, developing appropriate steps to improve effectiveness.
    • Coordinates internal compliance reviews and monitoring activities
    • Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
    • Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general training on how to avoid or deal with similar situations in the future.
    • Supports the maintenance of an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
    • Supports the development of materials at an organization-wide level for distribution to all employees to enhance awareness of compliance activities, including posters.
    • Develops tools, reports, tracking, and trending for the Corporate Compliance Department.
    • Develops, cultivates, and maintains working relationships with internal/external departments/agencies.
    • Coordinates investigations, mitigation, and other corrective action with appropriate workforce members.
    • Maintains HIPAA incident documentation in compliance with regulatory requirements for reported Privacy complaints or concerns.
    • Coordinates necessary operational changes and recovery efforts due to findings within the organization.
    • Has knowledge of commonly used concepts, practices, and procedures within the regulatory, insurance, and/or legal field.
    • Maintain attendance lists for all presentations, trainings, and keeps log of issues raised and identified for future research and response.
    • Develop educational materials related to compliance and regulatory issues.
    • In accordance with goals established by the Director of Compliance, completes reviews within established timeframes, analyze results and prepare formal reports with findings and recommendations.
    • Facilitate and improve staff understanding of regulatory and payer requirements by providing feedback related to documentation information.
    • Participate in the development and implementation of systems/procedures across facilities.
    • Other duties as assigned
    • Some domestic travel required. <25%

    Qualifications

    Educational Background and Experience:

     

    Education

    • Bachelors’ degree in healthcare, business or related field required, Master’s Degree preferred.
    • Compliance Certification from the Compliance Certification Board preferred, but not required.

     

    Experience

    • A minimum of three (3) years’ experience in a healthcare organization, to include demonstrated leadership skills. 
    • Previous experience in a Compliance role is required. Specific experience with healthcare regulatory, compliance-related auditing and monitoring, HIPAA Privacy and Security rules and regulations, and/or legal issues is strongly preferred.
    • Experience delivering training and presentations to a variety of audiences.
    • Experience conducting and coordinating audits.
    • Strong analytical, critical thinking, interpersonal, written and oral communication skills required.
    • Highly developed technical skills in the conduct of complex and sensitive compliance and fraud investigations preferred
    • Thorough understanding of ethics, regulatory agency regulations and laws in a healthcare environment preferred.
    • Proficient in Microsoft Office Suite required.
    • Demonstrated knowledge of data collection, analysis, reporting skills, project management, and documentation practices in a healthcare or regulatory compliance settings.


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