Compliance Review Specialist
Vidant Medical Group - Greenville, NC

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Position Summary

Knowledge of regulatory guidance impacting Vidant Health Physicians including but not limited to the OIG compliance guidance for Physician Practices, OIG annual work plan, HIPAA and Medicare/Medicaid billing guidelines. Maintains and updates Vidant Health Physicians Compliance Plan. Monitors select compliance criteria and appropriately maintains documentation of compliance activities. Performs initial survey and obtains background information relating to inquiries on activities and operations of a compliance nature by referring to and interpreting regulations, policies and procedures. Develops accessible lines of communication regarding possible fraudulent or erroneous conduct issues. Responds appropriately to detected violations through investigation of allegations and the disclosure of incidents to the Director of Clinical Quality.

Develops, coordinates and participates in training that focuses on the elements of UHS Compliance Plan, and seeks to ensure that training materials are appropriate. Conducts internal auditing and monitoring of provider documentation as prescribed by Vidant Health Physicians Compliance Plan.

Responsibilities

KEY RESPONSIBILITIES:

1. Knowledge of regulatory guidelines impacting Vidant Health including but not limited to OIG compliance guidance for Physician Practices, OIG annual work plan, HIPAA and Medicare/Medicaid billing guidelines.

a. Maintains and updates Vidant Health Compliance Plan.

b. Maintains documentation of all educational and auditing activities done, in keeping with Vidant Health Compliance Plan.

c. Provides information on the status of audits and answers compliance questions accurately for staff and management. Resourceful in researching regulatory topics for guidance.

2. Performs initial survey and obtains background information relating to inquiries on activities and operations of a compliance nature by referring to and interpreting regulations, policies and procedures.

a. Documents findings with support tied to regulatory guidance.

b. Recognizes and reports needed changes to Director, Clinical Quality.

c. Work with management team to develop policies and procedures.

3. Develops accessible lines of communication regarding possible fraudulent or erroneous conduct issues. Responds appropriately to detected violations through investigation of allegations and the disclosure of incidents to the Director, Clinical Quality.

a. Maintains user friendly process for anonymous report of suspected inappropriate activity and investigation of such activity.

b. Troubleshoots possible vulnerable areas.

c. Is easily accessible and maintains involvement in all areas of patient care, documentation and billing.

4. Develops, coordinates and participates in training that focuses on the elements of Vidant Health Compliance Plan, and seeks to ensure that training materials are appropriate.

a. Conducts individualized training based on audit results as prescribed by Vidant Health Compliance Plan.

b. Coordinates yearly training as prescribed by Vidant Health Compliance Plan. Ensures that staff engaged in billing and coding activities are appropriately updated on billing changes. Ensures that regulatory information and official notices are properly disseminated.

c. Demonstrate service excellence.

5. Conducts internal auditing and monitoring of provider documentation as prescribed by UHSP Compliance Plan.

a. Audits Vidant Health providers as prescribed by Vidant Health Compliance Plan.

b. Audits billing and coding processes as prescribed by Vidant Health Compliance Plan. Reviews and maintains records of audits of billing and coding performed by the CBO.

c. Use resources effectively and efficiently to achieve the goals and objectives of the department. Other duties as assigned.

Minimum Position Requirements

Four year college degree in Business major with concentration in health care preferred with three to five years of multidisciplinary physician practice environment required, academic medical center preferred. Liscensure in CPC or CCS-P required.

1 full - time vacancy.

General Statement It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

Vidant Health is an Equal Opportunity Employer. EOE/AA Applications for Vidant Health and its subsidiary corporate entities are accepted and employees are chosen for employment without regard to race, color, gender, religion, age, national origin, marital status, citizenship, veteran status, or disability.

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