Family Physicians Group
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at Family Physicians Group
The Compliance Professional (CP) will work closely with Compliance Management to support the Corporate Compliance Program. The CP position is expected to use independent judgment and leadership to provide key support in the areas of auditing, investigations, and assessing operational processes to ensure compliance with Federal, State, and local rules and regulations. The CP will report directly to the Compliance Director or Officer.
Essential Functions and Duties
- Conduct compliance audits as part of the compliance team, ensuring audits are performed in a timely manner and in accordance with established Federal, State, and other regulations and guidelines.
- Investigate compliance and regulatory complaints and inquiries received through the Compliance Hotline, internal reporting, or other reporting or monitoring mechanism, and prepare investigative reports and recommendations to Management teams.
- Act as a compliance department liaison with the business stake holders to provide compliance guidance and respond to related inquiries. Advises stakeholders of potential compliance risk areas.
- Tracks compliance issues, trend data, prepare regular reporting and provide compliance support to business stakeholders.
- Research compliance and regulatory rules and provide recommendations and/ or corrective action plans to Management teams to resolve the compliance and regulatory issues and ensure the compliance and regulatory issues do not reoccur.
- Strong analytical background with ability to review and evaluate information such as claims data, patterns and other supporting information related to case allegation details. Ability to carry out detailed written or verbal instructions, as well as respond to requests effectively and efficiently.
- Attend compliance department meetings and other interdepartmental meetings as needed.
- Initiate and manage ad-hoc assignments and responsibilities as needed.
- Ability to manage confidential information and/or issues using discretion and judgment.
- Travel to the clinic locations will be required.
- Strongly preferred: Degree in a Health Services, Public Health, Business Administration, Law, Healthcare Administration, Healthcare Compliance, or related field.
- Certification in Healthcare Compliance (CHC) or Certified Fraud Examiner (CFE) preferred, or ability to obtain certification within two (2) years of hire with the company.
- Previous experience in Medicare and/or Medicaid Managed Care, Special Fraud Investigations (SIU) and/or Medicare Advantage marketing compliance a plus.
- Minimum of two (2) years’ work experience in a health or business-related field with prior experience in health care compliance, clinical, health information management (HIM), coding, auditing, investigations, or related work experience required.
Knowledge, Skills, Experience and Abilities
- Strong verbal and written business communication skills: highly adept at synthesizing and summarizing complex and/or voluminous content into clear, concise and actionable communications;
- Demonstrates ability to identify appropriate resources. Exercises good judgment in terms of when to leverage internal resources;
- Must demonstrate working knowledge of the legal and regulatory environment, as it relates to healthcare compliance in Medicare, Medicaid, and clinical industries;
- Flexibility to work independently with self-initiative and limited direction yet be collaborative and team-minded in a fast-paced and deadline sensitive team structure.
- Ability to set priorities and work on multiple tasks in a fast-paced team-oriented environment.
- Demonstrated strong computer skills including Microsoft Office suite of software applications (Word, Excel, and PowerPoint).
- Ability to travel to the various clinic locations.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand and/or sit for extended period of time; walk and reach with hands and arms. The employee must occasionally lift, push, pull and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.