San Juan Regional Medical Center
Sr. Compliance and Privacy Analyst
San Juan Regional Medical Center, Farmington, New Mexico, us, 87499
Love what you do; Love where you live
•Love what you do; Love where you live. The Senior Compliance & Privacy Analyst serves as a regulatory privacy and compliance specialist within the Office of Compliance and Privacy at SJRMC, to help manage inquiries on a variety of compliance topics by gathering additional details on the questions/issues and conducting relevant research. The Senior Compliance & Privacy Analyst assists with ongoing implementation and maintenance of SJRMC's compliance program efforts; including, but not limited to: performing and coordinating monthly audits, reviewing risk metrics to identify trends, assist with making recommendations for audits and reviews, policy and procedure development, risk assessment, auditing and monitoring, training and education initiatives, and compliance programmatic developments and enhancements. This position will also assist in conducting compliance and privacy reviews and investigations through recommendations and corrective actions.
Required Behaviors
: As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission. Required Qualifications
:
Associate degree Minimum of three (3) years' experience in healthcare compliance or auditing Minimum of three (3) years' experience in privacy regulations and investigations Experience in healthcare Must achieve CHC certification within twelve (12) months from date of hire Preferred
Qualifications:
Bachelor's degree Possess one (1) of the following certifications: Certification in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA), Certification in Healthcare Privacy Compliance (CHPC), Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) or equivalent certifications Certification of CPC or other coding certification within twelve (12) months from date of hire Clinical experience working in a hospital environment Experience and thorough understanding of the False Claims Act Knowledge, Skills, and Competencies:
Excellent analytical, problem-solving, and decision-making skills Must be detail-oriented, take initiative to learn new tasks, and recommend improvements Ability to manage difficult, sensitive, and confidential situations unbiased with integrity and professionalism Strong ability to gather facts to analyze and understand the root cause/situational awareness Strong interpersonal skills: able to deal effectively with diverse skill sets, audiences and personalities Highly organized with proven ability to prioritize workload, meet deadlines, and manage several projects at one time Possess a high degree of flexibility to respond rapidly to changing goals, ability to work under pressure, and meet deadlines Excellent verbal and written communication skills Excellent writing, editing, and proofreading skills Executes all job responsibilities and assignments promptly, honestly, and ethically Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint), including creating charts and graphs Demonstrated knowledge of laws and regulations applicable to the healthcare provider industry Ability to explain complicated laws and regulations and implications of non-compliance in simpler terms understandable by all workforce members at all levels of the organization Excellent interpersonal, verbal, and written communication skills Excellent training and presentation skills Demonstrated success in building and maintaining collaborative work relationships (internally and externally) Duties and Responsibilities:
Assist and manage investigations for compliance and privacy concerns and/or violations through corrective actions Coordinate, monitor, and audit documentation. Audits will focus on medical necessity reviews, and clinical documentation to ensure that SJRMC is compliant with all regulatory guidelines and internal policies. Provide recommendations for educational opportunities and/or process improvement Conduct new caregiver orientation and ongoing trainings to all caregivers for compliance and privacy. Serve a resource and for all caregivers for compliance and privacy guidance. Analyze audit results; identify patterns, trends, or variations in coding and documentation practices and make recommendations for improvement Prepare quarterly compliance metric and audit reports for all findings/observations and provide appropriate recommendations Ensure any corrections are communicated to the Clinic Billing Office (CBO) in a timely manner. Track corrections, trends, and financial impact. Partners and collaborates with the various departments, caregivers, and Compliance leadership to develop process improvement and corrective action plans based on risk assessments, audit findings, and recommendations Performs trend analyses to identify and analyze clinical and compliance patterns/variations in coding and documentation practices Assist with policy and procedure development and revisions for Compliance and Privacy areas Maintains current knowledge of federal and state regulations and guidelines (CMS, OIG, etc.) keeping abreast of current changes that may affect healthcare systems Be a contributing and voting member of the Compliance Committee and ARAC (Audit and Risk Assessment Committee) Responsible for performing back-up coverage for system administration functions for the SJRMC contract approval and management platform and PolicyTech
•Love what you do; Love where you live. The Senior Compliance & Privacy Analyst serves as a regulatory privacy and compliance specialist within the Office of Compliance and Privacy at SJRMC, to help manage inquiries on a variety of compliance topics by gathering additional details on the questions/issues and conducting relevant research. The Senior Compliance & Privacy Analyst assists with ongoing implementation and maintenance of SJRMC's compliance program efforts; including, but not limited to: performing and coordinating monthly audits, reviewing risk metrics to identify trends, assist with making recommendations for audits and reviews, policy and procedure development, risk assessment, auditing and monitoring, training and education initiatives, and compliance programmatic developments and enhancements. This position will also assist in conducting compliance and privacy reviews and investigations through recommendations and corrective actions.
Required Behaviors
: As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission. Required Qualifications
:
Associate degree Minimum of three (3) years' experience in healthcare compliance or auditing Minimum of three (3) years' experience in privacy regulations and investigations Experience in healthcare Must achieve CHC certification within twelve (12) months from date of hire Preferred
Qualifications:
Bachelor's degree Possess one (1) of the following certifications: Certification in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA), Certification in Healthcare Privacy Compliance (CHPC), Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC), Certified Coding Specialist (CCS) by the American Health Information Management Association (AHIMA) or equivalent certifications Certification of CPC or other coding certification within twelve (12) months from date of hire Clinical experience working in a hospital environment Experience and thorough understanding of the False Claims Act Knowledge, Skills, and Competencies:
Excellent analytical, problem-solving, and decision-making skills Must be detail-oriented, take initiative to learn new tasks, and recommend improvements Ability to manage difficult, sensitive, and confidential situations unbiased with integrity and professionalism Strong ability to gather facts to analyze and understand the root cause/situational awareness Strong interpersonal skills: able to deal effectively with diverse skill sets, audiences and personalities Highly organized with proven ability to prioritize workload, meet deadlines, and manage several projects at one time Possess a high degree of flexibility to respond rapidly to changing goals, ability to work under pressure, and meet deadlines Excellent verbal and written communication skills Excellent writing, editing, and proofreading skills Executes all job responsibilities and assignments promptly, honestly, and ethically Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint), including creating charts and graphs Demonstrated knowledge of laws and regulations applicable to the healthcare provider industry Ability to explain complicated laws and regulations and implications of non-compliance in simpler terms understandable by all workforce members at all levels of the organization Excellent interpersonal, verbal, and written communication skills Excellent training and presentation skills Demonstrated success in building and maintaining collaborative work relationships (internally and externally) Duties and Responsibilities:
Assist and manage investigations for compliance and privacy concerns and/or violations through corrective actions Coordinate, monitor, and audit documentation. Audits will focus on medical necessity reviews, and clinical documentation to ensure that SJRMC is compliant with all regulatory guidelines and internal policies. Provide recommendations for educational opportunities and/or process improvement Conduct new caregiver orientation and ongoing trainings to all caregivers for compliance and privacy. Serve a resource and for all caregivers for compliance and privacy guidance. Analyze audit results; identify patterns, trends, or variations in coding and documentation practices and make recommendations for improvement Prepare quarterly compliance metric and audit reports for all findings/observations and provide appropriate recommendations Ensure any corrections are communicated to the Clinic Billing Office (CBO) in a timely manner. Track corrections, trends, and financial impact. Partners and collaborates with the various departments, caregivers, and Compliance leadership to develop process improvement and corrective action plans based on risk assessments, audit findings, and recommendations Performs trend analyses to identify and analyze clinical and compliance patterns/variations in coding and documentation practices Assist with policy and procedure development and revisions for Compliance and Privacy areas Maintains current knowledge of federal and state regulations and guidelines (CMS, OIG, etc.) keeping abreast of current changes that may affect healthcare systems Be a contributing and voting member of the Compliance Committee and ARAC (Audit and Risk Assessment Committee) Responsible for performing back-up coverage for system administration functions for the SJRMC contract approval and management platform and PolicyTech