Senior Compliance Analyst

St. Charles Health System; Bend (OR); On-site; USD 80,000 - 100,000; Full time

Job summary

St. Charles Health System in Bend, Oregon is looking for a Senior Compliance Analyst to assess and monitor compliance with laws and regulations. This role involves leading compliance initiatives, supporting enterprise risk management, and advising leadership on regulatory issues.

The ideal candidate will have over 5 years of healthcare compliance experience, particularly in a hospital setting, and will be responsible for identifying compliance risks and leading investigations. A bachelor's degree and relevant compliance certification are required.

Qualifications

• Minimum of 5 to 7 years of healthcare compliance experience necessary.
• Knowledge of healthcare regulations is essential.
• Experience with Medicaid and Medicare billing rules is required.

Responsibilities

• Monitor compliance with healthcare laws and regulations.
• Conduct risk assessments and identify compliance issues.
• Lead investigations into compliance concerns and violations.

Skills

Compliance knowledge

Analytical skills

Risk assessment

Interpersonal communication

Education

Bachelor’s degree in Health Science or related field

Tools

EHR systems (e.g. Epic)

Compliance management tools

Job description

Reporting to the Chief Compliance Officer, the Senior Compliance Analyst’s primary role is to assess and monitor SCHS activities for compliance with applicable laws, regulations, ethical standards, and system policies and procedures. The Senior Compliance Analyst is an advanced compliance professional and subject matter expert who develops and disseminates comprehensive resources, education and training programs, and coordinates activities to support compliance and operational policies and procedures. This position is responsible for leading complex compliance initiatives, supporting enterprise risk management activities, and serving as a key advisor to leadership on regulatory and compliance matters.

This position does not directly manage other caregivers, however, provides functional leadership and mentorship and may be asked to review and provide feedback on the work of other caregivers.

ESSENTIAL FUNCTIONS AND DUTIES

• Monitors and interprets federal, state, and local healthcare laws and regulations to ensure SCHS compliance and provides expert analysis of regulatory changes and organizational impact. This includes laws and regulations pertaining to participation in the Medicare and Medicaid programs, fraud and abuse, patient privacy, and billing and coding.
• Maintains knowledge of SCHS policies, procedures, and organizational standards and processes that support the seven elements of an effective compliance program as defined by the Office of the Inspector General.
• Serves as a collaborative resource to SCHS leadership, employees, and medical staff on compliance-related topics and issues and acts as a senior subject matter expert for complex or high-risk compliance concerns.
• Identifies compliance risk through a collaborative risk assessment process with key stakeholders, including the Compliance Steering Committee, and is a key contributor to the enterprise-wide compliance risk assessment by incorporating relevant information obtained through internal audits and investigations, the compliance hotline, the OIG work plan, and recent enforcement trends.
• Receives, triages, and disseminates compliance-related notifications received from CMS, OHA, OCR, HRSA, and OIG. Supports the organizational response to those compliance-related notices as requested by the Chief Compliance Officer.
• Assists in responding to regulatory investigations and periodic payor audits and assessments and may lead complex or high-risk responses to audits and investigations as assigned.
• Investigates and responds to reports of legal, regulatory, or policy violations and other compliance concerns received from SCHS caregivers and others, including leading complex, sensitive, or high-risk investigations and ensuring appropriate resolution and follow-up.
• Works with leadership to recommend and establish policies and procedures to address legal, regulatory, and other compliance-related matters and leads development or enhancement of policies addressing enterprise compliance risks.
• Champions compliance as a core business principle and empowers caregivers and providers to speak up and do the right thing.
• Identifies, and monitors, compliance trends and themes in data from complaint-driven investigations, routine and targeted audits, and related reports and performs advanced analysis to inform leadership decision-making and program improvements.
• Participates in and serves on SCHS committees, collaborates with business, operational, legal, and compliance stakeholders, and supports all compliance-related processes and activities, including without limitation, monitoring 340B program activities, OIG exclusion list compliance, annual compliance education & training, and OIG Audit Plan risk assessments. May lead subcommittees or workgroups as assigned.
• Partners with members of the compliance department, including privacy officers, internal auditors, and other compliance staff, to design the annual compliance, privacy, and audit plans and plays a key role in shaping and prioritizing those plans based on risk.
• Creates and maintains appropriate documentation of all compliance activities. Provides system-level leadership to establish and maintain open lines of communication within the organization to encourage the prompt reporting of compliance concerns. Develops, executes, and manages detailed project plans and status reports for complex or enterprise-level initiatives.
• Supports compliance program awareness through education, presentations, and development of communication materials.
• Serves as the Revenue Integrity and refund liaison.
• Supports the vision, mission, and values of the organization in all respects.
• Supports the Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change.
• Provides and maintains a safe environment for caregivers, patients, and guests.
• Conducts all activities with the highest standards of professionalism and confidentiality. Complies with all applicable laws, regulations, policies, and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner, reporting known or suspected violation of applicable rules, and cooperating fully with all organizational investigations and proceedings.
• Delivers customer service in a manner that promotes goodwill, is timely, efficient, and accurate.
• May perform other duties of similar complexity within the organization, as required or assigned.

Education

Required: Bachelor’s degree in a Health Science, Accounting, Business Administration, Pre-Law, Nursing, Health Information Management, or related field.

Preferred: N/A

Licensure/Certification/Registration

Required: Healthcare compliance or equivalent compliance certification (ex. CHC, CHRC, CHPC, CHC-F, or CCEP). Valid Oregon driver's license and ability to meet SCHS driving requirements. Ability to travel to business functions/trainings/meetings and all SCHS worksites.

Preferred: N/A

Experience

Required: Minium of five (5) to seven (7) years of healthcare compliance experience, preferably in a hospital or health system setting. Demonstrable knowledge and understanding of the healthcare industry’s regulatory environment. Skilled in researching state and federal laws, rules, and regulations. Must have experience with Medicaid, Medicare Part A and Part B billing and reimbursement rules. Must understand public and private healthcare payment systems, medical claims, and claims coding & editing. Must have familiarity with a variety of healthcare organizational constructs (home health, hospice, provider-based clinics, co-location, and JVs, etc.). Demonstrated experience leading investigations, compliance projects, or risk assessments.

Preferred: Additional experience in healthcare operations, finance or revenue integrity, quality or risk management, or human resources. Experience with Epic EHR. Experience mentoring staff or leading initiatives.