Healthcare Compliance Specialist

Drexel Co-op; Pennsylvania; Hybrid; USD 52,000 - 79,000; Full time

Job summary

Drexel University seeks a Healthcare Compliance Specialist to support Compliance Program Services, monitoring healthcare practices and educating clinical staff. The role focuses on regulatory compliance and risk management across university practices.

Top responsibilities include Medicare/Medicaid regulation research, audits of coding and billing, policy development, and staff training. Hybrid/flexible work arrangement and competitive compensation are offered.

Qualifications

• 3–5 years of experience in medical auditing, academic medicine compliance, coding, and reimbursement.
• CPMA certification.
• Physician coding certification (CPC or CCS-P).
• Ability to formulate compliance policies, procedures, and related documentation.
• Excellent communication and interpersonal skills.

Responsibilities

• Oversee the University’s health care compliance program.
• Serve as liaison between Compliance Program Services and clinical leadership.
• Research and analyze Medicare/Medicaid regulations applicable to the University.
• Perform Coding and Billing audits for Drexel Health clinical practices.
• Provide education and training to physicians and clinicians to remediate audit findings and manage risk.
• Develop and update healthcare compliance policies and procedures.
• Perform monthly screening against federal/state sanction databases and follow up as needed.
• Oversee annual CMS trainings and FDR attestations.
• Perform other duties as assigned by the Director, Compliance Program Services and/or Chief Compliance Officer.

Skills

Communication

Policy development

Spreadsheet skills

Diplomacy & confidentiality

Teamwork

Education

CPMA certification

CPC/CCS-P physician coding certification

Job description

Job Summary

The primary role of the Healthcare Compliance Specialist is to support the operational functions of Compliance Program Services by providing healthcare monitoring and education services for Drexel University clinical practices. The Healthcare Compliance Specialist is a regulatory expert who helps educate and advise the University toward excellence in healthcare compliance. The Healthcare Compliance Specialist reports to the Director, Compliance Program Services.

Essential Functions

• Oversee the University’s health care compliance program.
• Serve as primary liaison between Compliance Program Services and Drexel clinical directors and administrative leadership.
• Research and analyze current Medicare and Medicaid regulations applicable to the University.
• Maintain comprehensive knowledge of billing, reimbursement, and coding guidelines.
• Perform Coding and Billing audits for Drexel Health clinical practices.
• Provide education and training to Physicians and clinicians to remediate audit findings and manage risk.
• Develop and update healthcare compliance policies and procedures, as required.
• Perform and review monthly screening processes against federal and state sanction databases, ensuring system confirmations and associated follow ups, as necessary.
• Oversee and ensure completion of annual healthcare trainings required by Centers for Medicare and Medicaid Services.
• Complete and assure annual First Tier, Downstream or Related entity (FDR) attestations required by Centers for Medicare and Medicaid Services.
• Perform other duties as assigned by Director, Compliance Program Services and/or the Chief Compliance Officer.
• Other duties as assigned

Required Qualifications

• Minimum of a HS Diploma or GED
• Minimum of 3-5 years combined experience in medical auditing, academic medicine compliance, medical coding, office professional fee coding, and reimbursement.
• Certified Professional Medical Auditor (CPMA).
• Physician coding certification (CPC or CCS-P).
• Exceptional ability to formulate compliance policies, procedures, and related documentation.
• Exceptional communication and interpersonal skills.
• Expert spreadsheet and database management skills.
• Verifiable ability to maintain the highest level of diplomacy and confidentiality.

Preferred Qualifications

• Certified in Healthcare Compliance (CHC).
• Experience working in higher education and/or a complex organization a plus.
• Demonstrated ability to work effectively in teams and groups to plan, implement, and influence organizational change.

Location

• Hybrid/Flexible Work Arrangement

Additional Information

This position is classified as Exempt, grade J. Compensation for this grade ranges from $ 52,360.00 to $ 78,530.00per year. Please note that the offered rate for thisposition will vary based on thesuccessful candidate’s qualifications and experience, department budget, and an internal equity review.

Applicants are encouraged to explore the Professional Staff salary structure and CompensationGuidelines & Policies for more details on Drexel’s compensation framework. For information about benefits, please review Drexel’s Benefits Brochure.

A review of applicants will begin once a suitable candidate pool is identified.

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