Healthcare Compliance Specialist

Drexel University; Philadelphia (Philadelphia County); Hybrid; USD 33,000 - 79,000; Full time

Benefits offered by this job

Hybrid work arrangement

Job summary

Drexel University is seeking a Healthcare Compliance Specialist to support the Compliance Program Services for its clinical practices. The role focuses on regulatory education, audits, and policy development to uphold healthcare compliance standards.

The specialist will oversee the compliance program, liaise with clinical leadership, analyze Medicare/Medicaid rules, and conduct audits and trainings to remediate findings. Hybrid work arrangement with base in Drexel's Philadelphia campus.

Qualifications

• Minimum requirement is a HS Diploma or GED.
• 3–5 years of combined experience in medical auditing, academic medicine compliance, medical coding, and reimbursement.
• CPMA certification and CPC or CCS-P physician coding certification are required.
• Excellent ability to formulate compliance policies, procedures and related documentation.
• Strong communication, interpersonal, and confidentiality skills.

Responsibilities

• Oversee the University's health care compliance program.
• Serve as primary liaison between Compliance Program Services and clinical leadership.
• Research and analyze Medicare and Medicaid regulations applicable to the University.
• Maintain 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.
• Develop and update healthcare compliance policies and procedures.
• Conduct annual screenings against sanction databases and ensure follow ups.
• Oversee annual healthcare trainings required by CMS.
• Complete annual FDR attestations required by CMS.
• Perform other duties as assigned by leadership.

Skills

Healthcare compliance

CPMA

CPC/CCS-P

Communication skills

Interpersonal skills

Diplomacy & confidentiality

Spreadsheet & database management

Education

HS Diploma or GED

Tools

Excel

Database management

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 $ 78,530.00 per year. Please note that the offered rate for this position will vary based on the successful candidate's qualifications and experience, department budget, and an internal equity review.

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

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