Compliance Specialist

Appalachian Regional Healthcare (ARH); Lexington (KY); On-site; USD 65,000 - 90,000; Full time

Job summary

Appalachian Regional Healthcare (ARH) is seeking a Compliance Specialist – Coding and Billing to design and execute risk-based audits aligned with the annual plan. Collaborate with the Director of Coding and Billing Compliance and the Chief Compliance and Privacy Officer to strengthen ARH’s internal audits, controls, and governance in line with federal and state healthcare laws.

You will develop audit plans, analyze data, generate reports, and present findings to management, while maintaining

Qualifications

• Strong understanding of coding, internal auditing, or reimbursement laws.
• Excellent communication and collaboration skills.
• Demonstrated leadership abilities.
• Proficiency in data analysis and reporting tools.
• Ability to maintain confidentiality and handle sensitive information with discretion and professionalism.
• Ability to manage multiple deadlines and projects simultaneously.

Responsibilities

• Under minimal supervision, assists in developing comprehensive billing and coding audit plans.
• Generates reports and analyzes data from numerous databases and software systems across ARH.
• Executes audits and requested investigations independently.
• Performs/documents audit follow-up activities to ensure ongoing monitoring and that any requested corrective action plans are successfully implemented.
• Prepares clear, comprehensive written audit reports that include sufficient detail to explain the audit process and methodology, results, root cause analysis, and recommendations.
• Able to clearly and articulately discuss audit results with all levels of management, and assist with education as needed and appropriate.
• Maintains awareness of changes in statutes and regulations as well as compliance principles and practices in order to maintain professional competence.
• Reviews all relevant programs and activities affected by industry regulations and recommends changes to address company procedures and practices that are non- compliant.
• Participates in annual risk assessment and makes practical recommendations for process and/or policy improvements.
• Maintains coding certification.
• Provides education on coding and reimbursement updates as appropriate.
• Perform other duties as assigned.

Skills

Coding/auditing knowledge

Communication

Leadership

Data analysis

Confidentiality

Time management

Education

Bachelor’s Degree

Tools

Data analysis tools

Reporting tools

Job description

Overview

The Compliance Specialist – Coding and Billing will assist with the design and execution of risk-based compliance billing and coding audits in accordance with ARH’s annual audit plan and requested audits. The Compliance Specialist will work with the Director of Coding and Billing Compliance and the Chief Compliance and Privacy Officer to add value to ARH by bringing a systematic, disciplined approach to the creation and execution of the Compliance Department’s internal audits and investigations and following regulatory requirements, internal policies, and industry-accepted standards. The Compliance Specialist will help improve the effectiveness of the organization’s compliance program, internal controls, and governance processes, particularly within the area of adherence to federal and state healthcare laws and regulations. The successful candidate will be expected to work in a collaborative manner across multiple ARH departments, including the Organization’s Legal and Risk Departments.

Overview

The Compliance Specialist – Coding and Billing will assist with the design and execution of risk-based compliance billing and coding audits in accordance with ARH’s annual audit plan and requested audits. The Compliance Specialist will work with the Director of Coding and Billing Compliance and the Chief Compliance and Privacy Officer to add value to ARH by bringing a systematic, disciplined approach to the creation and execution of the Compliance Department’s internal audits and investigations and following regulatory requirements, internal policies, and industry-accepted standards. The Compliance Specialist will help improve the effectiveness of the organization’s compliance program, internal controls, and governance processes, particularly within the area of adherence to federal and state healthcare laws and regulations. The successful candidate will be expected to work in a collaborative manner across multiple ARH departments, including the Organization’s Legal and Risk Departments.

Responsibilities

• Under minimal supervision, assists in developing comprehensive billing and coding audit plans.
• Generates reports and analyzes data from numerous databases and software systems across ARH.
• Executes audits and requested investigations independently.
• Performs/documents audit follow-up activities to ensure ongoing monitoring and that any requested corrective action plans are successfully implemented.
• Prepares clear, comprehensive written audit reports that include sufficient detail to explain the audit process and methodology, results, root cause analysis, and recommendations.
• Able to clearly and articulately discuss audit results with all levels of management, and assist with education as needed and appropriate.
• Maintains awareness of changes in statutes and regulations as well as compliance principles and practices in order to maintain professional competence.
• Reviews all relevant programs and activities affected by industry regulations and recommends changes to address company procedures and practices that are non- compliant.
• Participates in annual risk assessment and makes practical recommendations for process and/or policy improvements.
• Maintains coding certification.
• Provides education on coding and reimbursement updates as appropriate.
• Perform other duties as assigned.

Education

• Bachelor’s Degree required

Minimum Work Experience

• Three (3) years of healthcare experience required
• Experience in coding, reimbursement, risk management, or regulatory compliance preferred

Licenses & Certifications

• Certification in Healthcare Compliance preferred

Required Skills, Knowledge, And Abilities

• Strong understanding of coding, internal auditing, or reimbursement laws
• Excellent communication and collaboration skills
• Demonstrated leadership abilities
• Proficiency in data analysis and reporting tools
• Ability to maintain confidentiality and handle sensitive information with discretion and professionalism
• Ability to manage multiple deadlines and projects simultaneously