Compliance Analyst & Auditor

Bargaining Unit: Non Represented - Professional

Rate of Pay: $56.14/hour DOE

Summary

Coordinates compliance and administrative functions associated with the implementation and management of Tahoe Forest Health System (TFHS) compliance activities. Collaborates with TFHS Legal, Compliance, Quality, Risk, HIM, Finance and other related departments.

Essential Duties And Responsibilities

• Implements and executes the compliance program and Code of Conduct in conjunction with the Compliance Officer including but not limited to to fraud and abuse laws, overpayments, gifts, conflicts and exclusions.
• Assists in maintaining the TFHS compliance program structure to reasonably ensure adherence to applicable federal and state rules and regulations related to health care.
• Monitors Compliance Hotline and E-mail, communicates any matter reported on the Compliance Department to the Compliance Officer and/or to other TFHS departments or managers.
• Assists the Compliance Officer to effectively investigate and respond to alleged compliance violations as directed.
• Developing/revising written policies, procedures, Code of Conduct and education focused on preventing and reporting illegal, unethical or improper conduct as directed.
• Performs research on compliance related issues.
• Provides compliance education to health care staff.
• Serves as liaison between Legal, Compliance, and other related departments as pertains to contracts, focusing particular attention on physician agreements and related issues.
• Performs audits in accordance with both the annual work plan and on an ad-hoc basis for newly existing issues related to various transactions, payments and billing practices.
• Maintains reports of such audits for internal or governmental purposes
• Assists the Compliance Officer with reporting to the Board of Directors.
• Attends applicable Board of Director’s meetings, governance meetings, or any other such meeting, as may be requested by the In-House Counsel.
• Conducts all activities with the highest standards of professionalism, discretion and confidentiality, recognizing the extreme sensitivity of the information and matters handled by the legal, risk and compliance teams.
• Demonstrates System Values in performance and behavior.
• Other duties as may be assigned
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervisory Responsibilities

No supervisory responsibilities.

Minimum Education/Experience

Bachelor's Degree from four-year college or university and 3 or more years relevant experience

Required Licenses/Certifications

Certified Healthcare Compliance (CHC)

• Within 2 years of hire into the job.
  
  

Other Experience/Qualifications

Required:

• Minimum three years of experience in business, legal and/or healthcare environment
• Excellent organizational skills
• Fact gathering and investigative skills
  
  

Preferred:

• Demonstrated knowledge of compliance and auditing
• Demonstrated knowledge of organizational policies and procedures for physician arrangements, billing, coding, and chart review