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Senior Healthcare Compliance Consultant

Expired Job

Change Healthcare Indianapolis , IN 46202

Posted 2 months ago

This position will provide healthcare regulatory compliance support within provider and payer clients and ensure the organization is working and operating in accordance with the most up to date applicable laws and regulations pertaining to federal and state regulatory requirements, including but not limited to regulations and guidance set by the Department of Health and Human Services (HHS) through the Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General (OIG), and the Office of Civil Rights (OCR) and applicable state mandated guidelines. The below responsibilities will be carried out and managed under the guidance and supervision of the Director. Primarily remote work; some onsite may be required and will vary by client request.
May provide project oversight and leadership to other team members.
Research and track applicable state and federal laws and agency regulations as they relate to client engagements.
Stay apprised of new regulatory developments and guidance by reviewing regulatory publications, applicable industry trade publications, legal requirements, pending legislation and past/current lawsuits and litigation as it relates to client projects.
Analyze the impact of applicable regulations and guidance on client organizations and create and implement audit and remediation plans.
Formulate and drive strategies to ensure client compliance with regulatory authorities and agencies.
Manage regulatory affairs projects and implement necessary programs, policies, procedures, or processes as they relate to regulatory compliance within the organization.
Update documentation, and provide education materials and general/targeted training relating to regulatory and guidance updates.
Attend calls, meetings, and other education sessions, as well as participate in workgroups to stay the most up to date on regulatory requirements.
Maintain expertise in assigned research topic(s) to support identified client regulatory compliance needs, and monitor and advise on practices and documentation related to regulatory compliance.
Actively participate in the development of client risk assessment plans, ongoing monitoring, policy and procedure development and processes as they relate to regulatory requirements and guidance.
May provide interim staffing for Compliance, Internal Audit and/or Enterprise Risk Management.
Assist with other compliance and auditing tasks as needed.
MINIMUM JOB Qualifications
Education / Training:
Bachelors Degree or 4 years equivalent on the job experience with progressing responsibility.
Must have a consulting background with a certification in healthcare compliance (CHC) -OR- accredited healthcare fraud investigator (AHFI) -AND- one of the following:

  • Certified Professional Coder (CPC)
  • Certified Coding Specialist (CCS)
  • Registered Health Information Technician (RHIT)
  • Registered Health Information Administrator (RHIA)
    A nursing background or certified internal auditor (CIA) would be a bonus but not required.
    Business Experience:
    Five (5) years experience in a role related to services of the division.
    Advanced knowledge of ICD-9-CM, ICD-10-CM, Official Coding Guidelines.
    In-depth understanding of laws, rules and regulations related:
    Healthcare Compliance, Ethics and HIPAA;
    Healthcare provider claim preparation, submission and billing (facility and professional fees);
    Federal health care programs and reimbursement cycle; and
    Services by acute and non-acute care hospitals
    Intermediate to complex knowledge of medical terminology, pharmacology and anatomy and physiology.
    Familiar with medical records content, format and other pertinent procedures.
    Proficient & competent computer skills including Microsoft Word, Excel and e-mail.
    Strong critical thinking skills.
    Excellent written and oral communication skills.

Healthcare, Compliance certification (CHC), Coding certification - CPC or CCS, fraud investigator (AHFI), RHIT, RHIA
6 months

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Senior Healthcare Compliance Consultant

Expired Job

Change Healthcare