FULL-TIME, 40 HOURS PER WEEK, DAY SHIFT, MONDAY - FRIDAY, 08:00AM - 05:00PM

SUMMARY: 

The Compliance Analyst will assist the Chief Compliance and Privacy Officer (CCPO) in the management of compliance oversight with relevant laws, regulations, and policies and procedures.  Responsibilities of this role will include monitoring the laboratory’s compliance with billing related laws, regulations and policies and procedures; and it will ensure third party requests for patient information are handled accurately and timely. 

PURPOSE:

The purpose of this document is to describe the general nature and level of work performed by personnel as classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.  

ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited to, the following:  

1. Coordinates or conducts routine reviews of laboratory processes and documentation to ensure compliant billing; prepares and presents reports of findings to internal stakeholders; coordinates the implementation and maintenance of compliance monitoring logs and reports.

2. Reviews laboratory CPT codes recommended by testing departments and reference laboratories, including but not limited to procedure codes associated with general laboratory, toxicology, pathology, molecular diagnostics, and genetics; maintains knowledge of and consults industry and payor reference materials and guidance; escalates to consultants as needed.

3. Responds to requests of patient health information (such as third party requests, subpoenas, court orders and warrants), scrutinizing for compliance, coordinating compilation of records for complex requests and litigation packets, and keeping accurate records of all release of information transactions for ease of retrieval in response to requests for accounting of disclosures.

4. Monitors and reports on completion of compliance and related education courses and sign-off of policies and procedures; follows up with staff and escalates noncompliance to management.

5. Participates in the development, maintenance and revision of and recommends changes to organizational and departmental policies, procedures, practices and education materials.

6. Manages data, data analytics and information systems for the Compliance Department.  This includes building an understanding of the laboratory’s information systems, uses, and how the Compliance Department can utilize the information for ongoing risk assessment, continuous monitoring of key controls and data analysis.

7. Provides administrative support by implementing systems, procedures, and policies; completes projects in support of compliance department initiatives; develops reports, and presentations, coordinates meetings, produces agendas and minutes, and tracks follow-up and completion of action items.

8. Maintains confidentiality of information (e.g., protected health information, personnel/management information, business information) obtained in the course of carrying out duties and responsibilities.

9. Enhances compliance department and organization reputation by accepting ownership for accomplishing new and different requests; explores opportunities to add value.

10. Maintains working knowledge of release of information laws and regulations, Medicare regulations, laboratory and pathology billing rules, and fraud and abuse laws, regulations, and industry guidance as applicable.

Required Skills

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, skills, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

  Education/Experience: 

Associate or bachelor’s degree or equivalent experience required. Minimum of 2 - 5 years medical laboratory billing experience required. The following skill sets are desirable: knowledge of the laboratory revenue cycle, knowledge of insurance billing processes and associated regulations, knowledge of the CPT/HCPCS Manual and CPT Assistant, knowledge of HIPAA compliance, ability to navigate federal and state laws, CMS and Novitas websites, auditing experience, strong analytical and investigative skills, project management skills.

  Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Convey a skilled phone manner for handling internal and external customer’s issues.

Math Ability:

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 

  Reasoning Ability:

Ability to work independently; demonstrate initiative and analytical ability; and possess excellent verbal and written communication skills.  Possess strong attention to detail, and highly organized. Demonstrate the ability to work with minimal supervision and direction. Ability to work well in a fast-paced professional office and laboratory environment. 

  Computer Skills: 

Demonstrates proficiency with Microsoft Office Word, Excel, and PowerPoint; and accepts new or changing computer technology as the norm.  Has the knowledge of and/or has the ability to quickly learn new computer processes. 

  Certificates and Licenses:

Coding certification from AAPC or AHIMA, or ability to obtain certification within six months of hire required.

Required Experience

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, skills, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

  Education/Experience: 

Associate or bachelor’s degree or equivalent experience required. Minimum of 2 - 5 years medical laboratory billing experience required. The following skill sets are desirable: knowledge of the laboratory revenue cycle, knowledge of insurance billing processes and associated regulations, knowledge of the CPT/HCPCS Manual and CPT Assistant, knowledge of HIPAA compliance, ability to navigate federal and state laws, CMS and Novitas websites, auditing experience, strong analytical and investigative skills, project management skills.

  Language Ability:

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Convey a skilled phone manner for handling internal and external customer’s issues.

Math Ability:

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations. 

  Reasoning Ability:

Ability to work independently; demonstrate initiative and analytical ability; and possess excellent verbal and written communication skills.  Possess strong attention to detail, and highly organized. Demonstrate the ability to work with minimal supervision and direction. Ability to work well in a fast-paced professional office and laboratory environment. 

  Computer Skills: 

Demonstrates proficiency with Microsoft Office Word, Excel, and PowerPoint; and accepts new or changing computer technology as the norm.  Has the knowledge of and/or has the ability to quickly learn new computer processes. 

  Certificates and Licenses:

Coding certification from AAPC or AHIMA, or ability to obtain certification within six months of hire required.