Compliance Specialist
Mary Washington Healthcare 59 reviews - Fredericksburg, VA

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- Bachelor's Degree
- 5 years related experience
Job Summary:

This position is accountable for coordinating complex corporate compliance activities for Mary Washington Healthcare and will serve as the Government Investigations/Recovery Audit Contractor (RAC) Coordinator for the health system.

This individual will support the mission, vision, values and strategic initiatives of Mary Washington Healthcare and must demonstrate a commitment to quality service to patients, physicians, the community, and co-workers.

Essential Functions & Responsibilities :

  • In collaboration with the Compliance Manager, implements the Compliance Program, including implementation of an annual work plan.
  • Serves as the Government Investigations/RAC Coordinator for the health system.
  • Prepares responses to and coordinates the tracking of government inquiries to ensure all deadlines are met.
  • Develops appeals and interacts with government investigators throughout the appeals process.
  • Forms and leads work teams to develop corrective action plans and implement corrective action plans on findings of audits/reviews.
  • Performs complex compliance risk assessments and audits.
  • Performs complex testing to monitor ongoing compliance with identified regulatory issues.
  • Prepares, develops, and presents reports regarding internal and external audits to include findings and recommendations.
  • Conducts complex research related to billing and compliance issues as they apply to Mary Washington Healthcare and assists with the analysis and interpretation of regulations, making recommendations to departments relative to compliance topics as needed.
  • Responds to compliance related questions
  • Educates on complex regulatory issues and finds to impacted staff of MWHC departments, including physician offices.
  • Communicates relevant regulatory issues and findings to appropriate departments and physician offices.
  • Perform other duties as assigned.

  • Bachelor’s degree in Finance, Business, Legal or Healthcare related is required.
  • RN or Masters preferred.
  • Minimum of five (5) years experience in a healthcare setting
  • At least one (1) year experience with the Recovery Audit Contractor program required
  • Understanding of medical record documentation and billing requirements.
  • General understanding of Mary Washington Healthcare operations.
  • Knowledge of Corporate Compliance programs as they apply to Health Systems.
  • Must have strong analytical skills, interpersonal skills, presentation skills, communication skills and research skills.
  • Strong computer skills, including the ability to access clinical information through MWHC’s information systems.
  • Ability to deal effectively with changing priorities and deadlines.

About this company
59 reviews