Compliance Specialist-Monitoring

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

Supports the Director of Compliance by researching and communicating State and Federal laws, regulations and policies that impact PHS Operations. . Assist with the Compliance HOTLINE and related activities to include directing of issues to the appropriate compliance or operations personnel. Conducts investigations of suspected issues of non-compliance as directed by the Director of Compliance or Compliance Manager. Conducts compliance-related audits or monitoring projects, monitoring corrective action plans and review for performance to plan. Performs policy and procedure review. Develop and monitor compliance indicators for CDS and Regional facilities, Ambulance Services and Home Health's. In coordination with the Director of Compliance will work with the HIPAA Privacy Officer on issues related to privacy and Section 1557 of the Affordable Care Act.

Some key responsibilities include:

• Facilitate interactions with Program, project, product line, senior executives, department managers, regional facility administrators and staff regarding regulatory compliance and related financial issues.
• Assist with the compliance HOTLINE process.*Facilitates cross-functional teams to address compliance issues that cross multiple departments or entities. Assists in the development and implementation of policies and procedures to address identified compliance issues.
• Conducts official compliance investigations, audits and monitoring activities to assure compliance with applicable laws, regulations and policies and procedures.
• Assists the Director of Compliance and Compliance Manager in conducting annual risk assessments related to the OIG Workplan and PHS identified risk area.
• As directed by the Director of Compliance or Compliance Manager, assists contracted internal audit in assuring the appropriate follow-up on recommendations from previous contracted internal audits or projects.
• As requested by the PHS Compliance Privacy Officer, conducts investigations and/or monitors information privacy issues or issues related to Section 1557 of the Affordable Care Act.
• Conducts and/or coordinates operational, financial and compliance program audits as directed by the Director of Compliance.
• Conducts regulatory research and serves as a resource for compliance information on regulations applicable to integrated healthcare systems.
• Performs compliance review of policies and procedures.
• Serves as the Compliance Department contact for system-wide Compliance Liaisons and coordinates and leads regularly scheduled telephone conference calls with these liaisons and other compliance personnel.
• Reports potential fraud and noncompliance to the Director of Compliance and Vice President of Corporate Compliance.
• Assists in the development, implementation and improvement of internal controls needed to assure regulatory compliance and compliance with PHS policies and procedures.
• Recommends corrective actions to prevent and resolve fraud or noncompliance and assists operational management in the implementation of solutions.
• As directed by the Director of Compliance, assists in the development of departmental or area compliance plans, monitors implementation and adherence to such plans.
• Serves as an additional compliance resource for HIPAA Privacy issues through cross training with other compliance personnel.
• Shares compliance learnings, finding and concepts with PHS staff at every opportunity.
• Performs other functions as required.

Qualifications:

• Bachelors Degree required
• Three to five years experience in healthcare compliance and/or healthcare auditing and monitoring.
• Familiarity with Healthcare Insurance Portability and Accountability Act

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.