Job Title: Compliance Coordinator
Department: Regulatory Compliance
Location: Riedman- Remote
Hours Per Week: Full-Time, 40 hours/week
Schedule: Day Shift
SUMMARY:
The Senior Corporate Compliance Coordinator plays a critical role in minimizing organizational risk by conducting comprehensive compliance audits, investigations, and training across all affiliates. This position provides guidance to system administration and management to ensure adherence to local, state, and federal laws, regulatory requirements, and contractual obligations. Serving as a subject matter expert, the Coordinator leads efforts to build and continuously optimize the organization's electronic medical record (EMR) system. Additionally, this role mentors and trains less experienced staff, offering support in resolving complex issues, technical challenges, and compliance-related questions.
Requires a high degree of mental and visual acuity, attention to detail, critical thinking and decision making. Exceptional analytical abilities, proven project management experience, and strong training skills are essential for guiding physicians, staff, and system leadership in accurately interpreting rules and regulations.
RESPONSIBILITIES:
· Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
· As a senior member, applies mastery of skills in area of specialization, provides guidance and general oversight to less experienced employees and may train new employees.
· Manages projects independently, prepares governmental disclosures and facilitates external audits by regulatory agencies when asked, while working with management.
· Coordinates and conducts audits to assess compliance with payer regulations and contract obligations. Audits include, but are not limited to revenue cycle (Clinical documentation, EMR workflows, registration, coding, charging, billing, payments, and denials), financial statements, payments, and attestations, grants, and screening employees and contractors for government exclusions and compliance with payment agreements.
· Conducts staff interviews with professionalism and respect to determine root causes of identified issues.
· Collaborates to discuss audit findings and offer advice and education as to how to improve compliance.
· Develops reports reflecting audit results and reports findings to Compliance leadership, and management.
· Develops corrective action plans with Management and assist with implementation when necessary.
· Performs follow-up audits to ensure controls are implemented and effective.
· Analyzes compliance studies that have been prepared by government and professional associations to assess risk and opportunity for assigned departments.
· Identifies compliance benchmarks for assigned areas and performs risk assessment analysis.
· Collaborates regularly with management to keep them informed of regulatory changes that may impact their departments.
· Conducts research and supports Compliance leadership, and management in initiatives related to new business growth across the system.
· Collaborates with system management on margin improvement initiatives, granting approvals as needed and providing training to staff involved in implementation to ensure compliance.
· Serves as a subject matter expert in the ongoing development and optimization of the system's EMR, focusing on clinical documentation, workflows, and revenue cycle impacts to ensure compliance. Delivers presentations to clinicians on proper documentation practices within the EMR.
· Designs and implements training to ensure compliance with the revenue cycle focusing on clinical documentation, coding, charging, billing, and denial appeals for physicians, health care providers, HIM coders and other applicable employees.
· Performs and manages internal investigations into reports of non-compliance (fraud, waste, and abuse) by employees or external sources as directed. Interviews system management and staff with respect and professionalism.
· Facilitates and manages under the general direction of Compliance Leadership external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare, and third-party payer fraud units.
REQUIRED QUALIFICATIONS:
· AAS or BS in Health Information Management, or Health Care Administration, and experience with healthcare compliance. A combination of healthcare work experience, credentials and/or education will be considered.
· Minimum five years of healthcare experience that includes a minimum of 3 years' health care compliance experience.
· Five years of progressive healthcare coding experience preferred, ideally extensive knowledge and experience with ICD-10-CM/PCS and CPT code assignment, principles and guidelines, reimbursement systems, and federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing.
· Formal training in auditing preferred.
Required Licensure/Certification Skills:
· RHIT, RHIA, CCS, CCS-P or applicable AAPC certification
· Relevant health care related certification with experience may be considered in lieu of above certifications.
· Compliance Board Certification a plus
EDUCATION:
LICENSES / CERTIFICATIONS:
PHYSICAL REQUIREMENTS:
S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.
Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.
PAY RANGE:
$66, $82,
CITY:
Rochester
POSTAL CODE:
14617
The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.
Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.