Description

Join a team of dynamic  health care professionals providing compliance and privacy services in the Life Plan/CCRC and post-acute environment. Great opportunity for professional growth and development.

The Clinical Compliance Specialist performs on-site compliance reviews and audits for a diverse group of organizations providing services in multiple states.  

• Conduct reviews and audits that encompass a variety of subject matter including those surveyed under State and/or Federal regulations, or laws with a focus on clinical services including professional standards of care.
• Assist with ensuring compliance with regulatory requirements associated with the Centers for Medicare and Medicaid Services (CMS), Office of inspector
• General (OIG), Office of Civil Rights (OCR), the Health Insurance Portability and Accountability Act (HIPAA) and state regulatory authorities.
• Review medical records, billing and associated supporting records to validate accurate comprehensive documentation that substantiates the medical necessity, quality of care, utilization of therapy services, and coding of claims associated with Medicare and/or Medicaid reimbursement.
• Assist with implementing recommendations or changes as necessary including education and training, developing clinical and operational policies and procedures, and guiding implementation of the organizations, systems or services that enhance organization compliance.

Essential Duties and Responsibilities

• Perform compliance audits for organizations in areas surveyed by State and Federal regulation and law.
• Assist with ensuring compliance with Medicare, Medicaid documentation, coding and billing rules and HIPAA regulations.
• Assist in monitoring the activities and regulations of the Centers for Medicare and Medicaid services and various state Departments of Health.
• Contribute to the development and implementation of programmatic changes and development and provision of participant support through email and phone contact.
• Travel to offsite locations. Overnight travel is required.

Requirements

Desired Skills & Experience

• Minimum of 7 years’ experience in the Long-Term Care, Post-Acute/Healthcare industry. Experience with documentation, coding and billing for Part A services a must.  
• Bachelor’s Degree: Nursing or Physical Therapy, Occupational Therapy, Speech Therapy
• Extensive knowledge of Medicare and Medicaid Coding and Billing in the post-acute environment.
• The ability to be flexible and adapt to changing regulatory environment is a must.
• Strong written and verbal communication skills.
• Ability to travel and work independently.