Compliance Coordinator

Rochester Regional Health; City of Rochester, Northern (NY, KY); Hybrid; USD 63,000 - 78,000; Full time

Benefits offered by this job

Remote work

Job summary

Rochester General Health System is seeking a Corporate Compliance Auditor to minimize risk through audits, investigations and training across affiliates. You will guide system administration and EMR optimization, ensuring compliance with laws and contracts.

The role requires a high level of professionalism, confidentiality, and strong communication skills. Responsibilities include leading audits, reporting findings to leadership, developing corrective actions, and conducting follow-ups.

Qualifications

• Strong communication skills as noted in responsibilities.
• Analytical skills and project management experience.
• Training skills for staff and clinicians.
• Attention to detail and compliance focus.

Responsibilities

• Abides by and promotes Ethical Coding standards per AHIMA.
• Manages projects independently, prepares disclosures, and facilitates external audits.
• Coordinates audits to assess payer regulations and contract obligations across revenue cycle and related areas.
• Interviews staff professionally to identify causes of non-compliance.
• Educates clinicians and staff on compliance improvements and best practices.
• Develops audit reports and presents findings to Compliance Director and management.
• Develops corrective action plans and assists with implementation.
• Performs follow-up audits to ensure monitoring effectiveness.
• Analyses government and professional studies to assess risk for departments.
• Identifies compliance benchmarks and conducts risk analyses.
• Collaborates with system leadership on regulatory changes affecting departments.
• Supports approvals for new business growth and margin improvement initiatives.
• Acts as SME for EMR optimization in documentation, workflows and revenue impact.
• Designs and delivers training on Fraud, Waste and Abuse, revenue cycle tasks.
• Conducts internal investigations into reports of non-compliance.
• Documents findings and coordinates HR actions when needed.
• Represents RGHS with agencies during external investigations.

Skills

Communication skills

Analytical skills

Project management

Training skills

Attention to detail

Education

AAS/BS in Health Information Management / Health Care Administration / Finance / Accounting

Job description

Position Summary

Minimizes risk to the organization by conducting Corporate Compliance audits, investigations and training throughout all affiliates. Guides system administration and RGHS management to ensure compliance with local, state and federal laws and regulations; in addition to contract obligations. Acts as subject matter expert for building and continually optimizing the system’s EMR. Work is often confidential and sensitive; therefore requires a high level of professionalism and strong communication skills. Requires a high degree of mental and visual acuity as attention to detail, critical thinking and decision making is required. Errors greatly impact the hospital’s compliance risk, including legal fines, loss of revenue and statistics. Strong analytical skills, project management experience, and training skills to guide Physicians, staff and system Management in interpretation of rules and regulations are essential.

Status

Full-Time

Department

Compliance

Location

Remote

Schedule

Monday-Friday, 8:00am - 4:30pm

Key Responsibilities

• Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association.
• Manages projects independently, prepares governmental disclosures and facilitates external audits by regulatory agencies while working with RGHS Administration and Management.
• Coordinates and conducts audits to assess compliance with payer regulations and contract obligations. Audits include, but not limited to revenue cycle (Clinical documentation, EMR work flows, registration, coding, charging, billing, payments and denials), financial statements, payments and attestations; grants, RGHS employees and contractors for governmental exclusions and payment agreements
• Interviews key staff with professionalism and respect in order to identify cause analysis of issues identified.
• Collaborates with health care professionals to discuss findings and offer advice and education as to how to improve compliance
• Develops reports reflecting audit results and reports findings to Compliance Director, RGHS Administration and management
• Develops corrective action plans with Management and assists with implementation when necessary.
• Performs follow up audits to ensure monitors are implemented and effective.
• Analyzes studies that have been prepared by government and professional associations to assess risk and opportunity for assigned departments
• Identifies compliance benchmarks for assigned areas and performs analysis for risk assessment
• Collaborates with System Directors and/or administration regularly to ensure awareness of any regulation changes impacting their departments
• Researches and assists Compliance Director, RGHS management and administration with approvals for new business growth for the system
• Approves and collaborates with system management and administration on margin improvement initiatives, often times assists or provides the training to staff involved in implementing, to ensure compliance
• Acts as Subject Matter Expert in the continued building and optimization of the systems EMR in areas of clinical documentation, work flows and impacts on the revenue cycle to ensure compliance. Performs presentations for clinicians on appropriate documentation in the EMR
• Designs and implements training to ensure compliance. Focuses include, but not limited to Fraud, Waste and Abuse, revenue cycle clinical documentation, coding, charging, billing and denial appeals for physicians, health care providers, HIM coders and other applicable RGHS employees
• Performs and manages internal investigations into reports of non compliance (fraud, waste and abuse) by RGHS employees or external sources as directed
• Interviews system management and staff with respect and professionalism
• Completes report and investigation in a timely manner
• Reports findings to Compliance Director and follows through as directed; including assisting HR with information and interviews to ensure appropriate discipline of employees
• Performs cause analysis of non compliance
• Facilitates corrective action and monitors in affected departments with management
• Performs follow up audits in timely manner to ensure compliance
• Facilitates and manages under the general direction of Compliance Director external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare and Third Party payer fraud units. Represents the system in a positive and professional manner when communicating with agencies.

Minimum Qualifications

• AAS or BS in Health Information Management, Health Care Administration, Finance, or Accounting, and experience with healthcare compliance. A combination of healthcare work experience, credentials and/or education will be considered.
• Minimum five years of healthcare experience with CMS and local payers regulations.

Required Licensure/Certification Skills

• RHIT, RHIA, CCS or CCS-P preferred.
• Relevant health care related certification or other experience may be considered in lieu of above certifications.
• Compliance Board Certification a plus

Rochester General Health System is an Equal Opportunity / Aff… Minority/Female/Disability/Veteran

Physical Requirements

Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.

Pay Range

$63,000.00 - $78,000.00