Working under the direction of the Compliance Program Manager, works in partnership with more senior team members, with assigned client organizations.
In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities, under the leadership of more senior team members, include:
Planning: participating in the identification of compliance accountabilities; participating in the development of Compliance, Work, and Audit plans; participating on compliance-related committees/work groups,
Implementing: participating in the identification of compliance requirements and conducting portions of related analyses; participating in the creation or revision of compliance standards, policies, and procedures; may monitor compliance adherence; prepares reports on compliance efforts and programs), and
Validating: reviewing compliance programs and content, including participating in risk assessments and/or audits, and participating in the investigation of instances of reported non-compliance.
Essential Functions:
- Scope/Job Complexity:
- Works on assignments of limited scope.
- Works within accepted guidelines.
- Requires limited planning and scheduling.
- Business Impact:
- Responsibilities impact the achievement of team objectives.
- Results usually contribute to the completion of projects and team objectives.
- Typical errors would cause limited delays, inefficiencies and/or expenses.
- Decision-making:
- Typically involves interpreting and carrying out general guidelines.
- Requires limited judgment to develop alternatives.
- Provides information to others to be used in the decision-making process.
- Requires limited decision-making within clearly defined parameters.
- Problem Solving:
- Develops solutions to a variety of problems of limited scope and complexity using limited judgment within clearly defined practices and procedures.
- Assesses information to identify the best solution from existing alternatives.
- Interactions and Communications:
- Exchanges and interprets routine information and/or collaboration of work.
- Coordination of reports and data.
- Communicates policies, practices, procedures of a routine, non-interpretive nature.
- Independence/Discretion:
- Follows generally defined directions.
- Works under general supervision.
- Exercises limited discretion within defined boundaries.
- Will seek a supervisor or manager to provide guidance and/or solve problems for difficult issues.
- Management of Staff:
- Has no formal supervisory responsibility.
Qualifications:
Basic Qualifications:
- Bachelor's degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field.
- Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred. If applicant does not have the CHC, then must complete within 12 calendar months of hire.
- Minimum of 3 years of experience in specified technical area
- Ability to determine key business issues and develop appropriate action plans from multi-disciplinary perspectives.
- Demonstrated ability to conduct and interpret quantitative and qualitative analyses of compliance cases.
- Good project management and consulting skills.
- Excellent verbal and written communication skills.
- Some knowledge of health care compliance policies, practices and systems.
- Limited use and/or application of basic compliance principles, theories, and concepts.
- Limited knowledge of health care industry practices and standards.
- Ability to draft and revise documents including policies, standards, analyses, and reports.
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- Minimum of one(1) year of experience with the Compliance Case Management system (TrakWeb)
- Focused experience with Revenue Cycle Management
-Proficiency with Excel and Access
- Ability to prepare data analyses and prepare reports
- Knowledge of regulatory billing requirements for CMS, Workers Compensation, Third Party Payors, and Medicaid for both Hospital & Professional billing
- Ability to research and analyze data to determine where problems exist.
- Experience with conducting assessments ofbilling documentation and data, and developing solutions.
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.