Compliance Specialist, Senior

Fred Hutch Cancer Center; Seattle (WA); On-site; USD 95,000 - 143,000; Full time

Benefits offered by this job

Medical/Vision

Dental

Flexible spending accounts (FSA)

Life Insurance

Disability Insurance

Retirement Plan

Paid Vacation

Paid Sick Leave

Paid Holidays

Paid Parental Leave

Onsite Health Clinic

Tuition Reimbursement

Employee Assistance Program

Job summary

Fred Hutchinson Cancer Center in Seattle seeks a Compliance Specialist, Senior to lead auditing and monitoring activities within the Compliance Office. You will collaborate with Revenue Cycle, Quality, Pharmacy, and Laboratory to ensure adherence to laws, regulations, and enterprise policies.

The role requires extensive knowledge of healthcare reimbursement and coding, with oversight of audit reports and education programs across clinical and research settings.

Qualifications

• Bachelor's degree is required.
• Five years of experience in healthcare reimbursement/coding operations or compliance including internal audits or hospital billing and coding audits.
• Extensive knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding principles.
• Strong critical thinking and data analysis abilities.

Responsibilities

• Assist Compliance Office in executing auditing and monitoring plans.
• Respond to inquiries, requests for consultation, and complaints.
• Prepare written reports of audit findings/results with recommendations for improvement.
• Assist in tracking health care reimbursement compliance risk assessments and communicate results to Compliance Leadership.
• Develop education and internal controls for reimbursement and coding.
• Develop standard compliance reports and communicate findings to Senior Manager.
• Maintain knowledge of HIPAA, OIG activities, and other regulations.
• Perform other duties as assigned.

Skills

Healthcare reimbursement

Coding operations

Internal audits

Data analysis

Critical thinking

Education

Bachelor's degree

Tools

Data mining software

Tracking software

Job description

Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, Fred Hutch is the only National Cancer Institute-designated cancer center in Washington.

With a track record of global leadership in bone marrow transplantation, HIV/AIDS prevention, immunotherapy and COVID-19 vaccines, Fred Hutch has earned a reputation as one of the world’s leading cancer, infectious disease and biomedical research centers. Fred Hutch operates eight clinical care sites that provide medical oncology, infusion, radiation, proton therapy and related services, and network affiliations with hospitals in five states. Together, our fully integrated research and clinical care teams seek to discover new cures to the world’s deadliest diseases and make life beyond cancer a reality.

At Fred Hutch we value collaboration, compassion, determination, excellence, innovation, integrity and respect. Our mission is directly tied to the humanity, dignity and inherent value of each employee, patient, community member and supporter. Our commitment to learning across our differences and similarities make us stronger. We seek employees who bring different and innovative ways of seeing the world and solving problems.

Reporting to the Compliance Director, the Compliance Specialist, Senior works within the Compliance Office and collaborates with the Revenue Cycle, Quality, Pharmacy, Laboratory and other partners across the enterprise to ensure compliance with applicable laws, regulations and enterprise policies. The Compliance Specialist, Senior, will plan and conduct compliance audits and serve as a content expert for health care reimbursement/billing compliance activities within the Compliance Office; respond to inquiries, investigate complaints, prepare audit reports, develop and deliver education and outreach, report on program activities, maintain program records, and monitor regulatory developments; and assist with the creation and review of policies and procedures. Working with both internal and external stakeholders, the Compliance Specialist, Senior, helps establish and maintain a health care reimbursement/billing compliance risk assessment, auditing and reporting program.

At Fred Hutchinson Cancer Center, all employees are expected to demonstrate a commitment to our values of collaboration, compassion, determination, excellence, innovation, integrity, and respect.

Responsibilities

• Assist the Compliance Office inexecuting an effective auditing and monitoring plan by conducting independent and integrated compliance audits and investigations.
• Receive and respond to generated inquiries, requests for consultation, and complaints.
• Prepare written reports of audit findings/results, including recommendations for improvement and corrective actions (e.g. refund identified overpayments).
• Assist in tracking and conducting health care reimbursement compliance risk assessments, identify high risk areas and communicate results to Compliance Leadership, Health Care Reimbursement Compliance.
• Assist in the development, implementation and maintenance of clinical and research reimbursement and coding compliance education, training and internal controls (i.e. policies and procedures).
• Develop standard compliance reports to communicate findings and call attention to trends. Provide reports on these activities to the Senior Manager for further distribution as needed.
• Maintain working knowledge in current health care compliance issues, OIG enforcement activities, and other applicable regulations such as HIPAA, licensure requirements, and quality standards.
• Perform other duties as may be assigned.

Qualifications

Required:

• Bachelor's degree.
• Minimum five years of experience related to health care reimbursement/ coding operations or compliance including experience conducting internal audits or hospital billing and coding audits and written reports of findings.
• Extensive knowledge of ICD-9-CM, ICD-10-CM, CPT, and HCPCS coding principles and guidelines.
• Strong critical thinking and data analysis abilities including the ability to gather information from multiple sources, including but not limited to sophisticated data mining programs and software, to gain a thorough understanding of problems/issues.

Preferred:

• Certified Professional Coder - Hospital (CPC-H) and/or Certified Medical Audit Specialist (CMAS).
• Use of software tracking mechanisms for compliance issues.
• Understanding of the revenue cycle and clinical trial/research billing processes.
• Extensive knowledge of compliance program requirements, principles, and guidelines.

The annual base salary range for this position is from $95,493.00 to $143,208.00, and pay offered will be based on experience and qualifications.

Although Fred Hutch is not sponsoring most H-1B visas at this time, candidates who already hold an H-1B sponsored by another organization and are currently in the U.S. may be eligible for this position.

Fred Hutchinson Cancer Center offers employees a comprehensive benefits package designed to enhance health, well-being, and financial security. Benefits include medical/vision, dental, flexible spending accounts, life, disability, retirement, family life support, employee assistance program, onsite health clinic, tuition reimbursement, paid vacation (12-22 days per year), paid sick leave (12-25 days per year), paid holidays (13 days per year), paid parental leave (up to 4 weeks).