Senior Compliance Specialist

Contributes to the fulfillment of the Renown Health purpose by promoting a culture of ethical and compliant behaviors and practices accomplished through planning, coordinating, implementing and maintaining a system-wide compliance program as part of the Renown Health Corporate Compliance Program, inclusive of the Hometown Health Compliance Program. This compliance program provides education, guidance, audits and monitoring of billing and health plan activity for Renown Health and delegated entities. Serves as the primary Renown Health resource regarding issues related to billing or health plan compliance, which may include appropriate Renown business practices for patient registration, documentation, coding, and claim submission or appropriate Hometown Health business practices for member enrollment, claim adjudication, provider network standards, marketing, call center operations, utilization management. In collaboration with the Internal Audit Department also supports projects related to compliance risk assessments, compliance audit and self-monitoring programs, and compliance audits conducted by independent outside firms.

This position is responsible for identifying and assessing areas of compliance risk; assisting with the development and implementation of compliance training and education programs; serving as a point of contact for Renown Health or Hometown Health employees regarding potential compliance concerns and questions; researching federal and state regulations; monitoring and communicating regulatory changes that impact Renown Health and delegated entities; and supporting compliance leadership in timely detection, response, investigation, analysis and applicable corrective action pertaining to any compliance matter.

The Senior Compliance Specialist may chair or co-chair the various Compliance Committees.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. The responsibilities of this position may include the performance of other duties.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Name

Description

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English. A Master's in Healthcare or Business Administration is preferred. Educational requirements may be waived if extensive working experience is demonstrated.

Experience:

8 years of health care billing or regulatory experience.

Preference will be given to those applicants with experience in more than one setting (i.e. skilled nursing facilities, acute hospital, home health, physician office, health plan, etc.) and/or clinical experience.

License(s):

None

Certification(s):

Must have and maintain two of the following certifications: CHC (Certified in Healthcare Compliance), CHPC (Certified in Healthcare Privacy Compliance), CHRC (Certified in Healthcare Research Compliance) CCEP (Certified Compliance and Ethics Professional), CPC (Certified Professional Coder), CIC (Certified Inpatient Coder) or another certification approved by leadership.

Computer / Typing:

Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.