Compliance Consultant

About the Job

Location: New Hanover Regional Medical Center

Department: Corporate Compliance

Full Time Equivalent: full-time

Work Type: 64 to 80 Hours Pay Period

Work Schedule: STD HRS - Standard-Exe or Office w flex

Exempt from Overtime: Exempt: Yes

What You'll Do

Summary:

The team member’s Number One job responsibility is to deliver the most remarkable patient experience, in every dimension, every time, and understand how he or she contributes to the health system’s vision of achieving that commitment to patients and families. 

The Compliance Consultant is responsible for working with Compliance leaders to: 

• Ensure Novant Health and its affiliates compliance with state and federal regulatory requirements (including, but not limited to Medicare, Medicaid, and Tricare); 
• Interpret regulations and identify compliance requirements;
•  Audit, monitor, and investigate compliance with applicable regulations;
•  Analyze and apply applicable regulations to different questions, projects, or inquiries presented to the Compliance team; 
• Support operational staff by identifying likely risks, and recommending monitoring protocols and efficient, effective internal controls that support business goals; 
• Support workforce education about compliance requirements; 
• Review or draft policy language to reflect compliance and business-driven changes; 
• Oversee compliance projects, including planning and training other team members assigned to projects.

Responsibilities:

 ESSENTIAL FUNCTIONS 

1. Monitoring: Be familiar with area under review. If necessary, visit department/facility/clinic to gain process knowledge. Research all relevant materials, including but not limited to, regulations, policies, procedures, and other standards. Assist with and/or formulate monitoring protocols and tools. Assist with and/or implement monitoring activity. Assist with and/or analyze monitoring findings. Assist with and/or provide communication of monitoring results to department leadership. Document monitoring work and findings in accordance with department standards. 
2. Audits: Assist with and/or perform work outlined in audit plan as directed, excluding those audits performed by the Compliance Audit team. Assist with and/or obtain, analyze, and appraise data to identify and evaluate the system of control in the area under review. Document audit work and findings in accordance with department standards. Assist with and/or identify control weaknesses, analyze the effect of the weaknesses, research causes, and formulate recommendations. Assist with and/or provide communication of audit findings to department leadership as directed by management. 
3. Investigations: Assist with and/or perform interviews, data collection, and analysis. Gather and document other evidence as needed, and assist with and/or provide interpretation and analysis of evidence. Document findings in accordance with department standards. Assist with and/or communicate findings as directed by management. 
4. Consultations: Assist with and/or collaborate with stakeholders to understand operations as they interface with the area of expertise. Assist with and/or research, analyze, interpret, and apply regulations as needed or requested by operational leaders. Assist with and/or assess workflows with a critical eye, to assist in the development of policies, procedures, workflows, or other operational functions by ensuring adherence to applicable regulatory requirements. 
5. Education: Assist with and/or conduct or facilitate meetings where information is shared with operational departments concerning new regulations and enforcement activities or other standards. Assist with the development of appropriate compliance training and education programs for all Novant Health team members, including understanding and communicating the elements of the compliance program. 
6. Communications: Assist with and/or coordinate with other departments/facilities/clinics to ensure cohesive support of compliance functions. Ability to absorb information and form appropriate conclusions, and apply general rules to specific problems and produce well-thought answers. Creates an environment that supports and respects diversity and inclusion in order to promote creative problem solving. 
7. Professional: Read trade journals/book/articles related to compliance and auditing in areas of expertise. Attend education/training events (internal and external). Share knowledge with department and stakeholders. Serve as a role model for ethical conduct, including the ability to convey a positive, professional image. 

All other duties as assigned. 

Position Requirements

Education:  Bachelor’s Degree required. Master’s Degree in relevant field preferred (MBA, MHA, JD, other Master's Degree in relevant field)

Licensure/Certifications: Preferred: CHC, RHIA, RHIT, CPC, CCS, RN, LPN, CNA, CMA, MT(ASCP), RRT, RCP, Rpham, JD 

Experience: Minimum 1 year healthcare industry required. Minimum 1 year healthcare compliance or related audit experience preferred.

Additional Skills/Requirements required:

The Compliance Consultant has: 

• Limited to basic knowledge, skills, and abilities regarding accounting standards and financial statement analysis; 

• Basic to intermediate knowledge, skills, and abilities regarding legal standards and internal controls; 

• Basic to intermediate knowledge, skills, and abilities regarding analytical skills, listening, interviewing, writing, and presenting;

 • Basic to intermediate knowledge, skills, and abilities regarding clinical documentation, coding, and billing; 

• Basic to advanced knowledge, skills, and abilities regarding researching regulations and standards, reimbursement protocols, understanding operations as they interface with the area of expertise, and compliance program requirements;

 • Basic to intermediate proficiency with Microsoft applications, and other applications required for area of expertise, including data and evidence analysis; and 

• Ability to drive/travel to multiple locations/facilities as needed. 

Other Information