Compliance Specialist

Job description

Tennessee Oncology, one of the nation’s largest, community-based cancer care specialists, is home to one of the leading clinical trial networks in the country. Established 1976 in Nashville, Tennessee Oncology’s mission remains unchanged: To provide access to high-quality cancer care and the expertise of clinical research for all patients, at convenient locations within their community and close to their home. Our growing network of physicians and locations is based on this mission. Tennessee Oncology is committed to advancing both the science of detection and targeted treatments, and to making these advances available to every patient. We believe caring for cancer patients is a privilege. Why Join Us? We are looking for talented and highly-motivated individuals who demonstrate a natural desire to support the meaningful work of community oncologists and the patients we serve. Job Description: The compliance specialist provides compliance and privacy support to the organization. Their duties may include conducting audits, monitoring actions plans, investigating matters as assigned, providing education and training, and participating in projects to help ensure that Tennessee Oncology is compliant with local, state, and federal laws, rules, and regulations. ESSENTIAL FUNCTIONS: Will assist Chief Compliance & Privacy Officer with day-to-day operations of the department. Assist with preparing audit work papers and reports to effectively conduct, document, and communicate all compliance audit activities. Audits will include coding, billing, provider documentation, and reimbursement processes and others as assigned. Compose reports which accurately outline any findings as a result of the audit work. Assist with conducting annual compliance risk assessments, work plans and action plans that mitigate findings. Assist in investigations of compliance and privacy concerns. Assist with complete, accurate and timely closure documentation of complaints from patients, staff, and internal or external providers, including hotline complaints. Create and maintain compliance and privacy event logs. Establishes a structured process for tracking new and upcoming regulatory changes and collaborate with other departments to develop and initiate plans to educate Tennessee Oncology employees on relevant regulatory program requirements. Assist in the development and provision of compliance and privacy training for providers, employees, and other workforce members. Will track completion rates of all employees, both for New Hire and Annual Training Assignments. Assist with creating and reviewing compliance policies and procedures. Participate in periodic reviews and revisions of the Notice of Privacy Practices, Code of Conduct and other regulatory documents as needed. Responsible for reviewing and resolving the OIG Exclusion List on a monthly basis. Responsible for compliance and privacy walk-throughs in all Tennessee Oncology locations. Maintain a strong working knowledge of local, state, and federal rules and regulations. Researches and answer questions from staff regarding compliance and privacy regulations. Perform USER activity audits as assigned. Perform duties in accordance with Tennessee Oncology mission, values and policies and procedures. Perform other duties as assigned. KNOWLEDGE, SKILLS & ABILITIES: Ability to work independently, excellent investigative skills, the ability to communicate effectively and a high level of integrity and confidentiality. Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position. Knowledge of and ability to utilize conflict resolution and problem-solving techniques. Must be proficient in the use of Microsoft Word, Excel, Visio, and PowerPoint. Ability to prioritize tasks and meet deadlines. Must maintain a valid driver’s license. EDUCATION & EXPERIENCE: A minimum of an associate degree, bachelor preferred, in a healthcare related field and at least 5+ years healthcare compliance and / or privacy experience. Compliance and / or privacy certification(s) desired but not required. Healthcare organization knowledge of operations, quality assurance, HIPAA, revenue cycle management, coding and billing, safety, federal and state healthcare regulations. Knowledge of current laws, regulations, administrative guidance and industry practices that affect compliance obligations including Stark, Anti-kickback, HIPAA, Medicaid/Medicare regulations, and CMS Fraud, Waste, and Abuse guidelines. PHYSICAL REQUIREMENTS: Job Title: Compliance Specialist Physical Activity Required Amount of time None Less than 1/3 (Occasionally) 1/3 to 2/3 (Frequently) More than 2/3 (Regularly) Standing X Walking X Sitting X Fingering or manual dexterity X Repetitive finger motion X Lifting or exerting force Up to 10 pounds X Up to 25 pounds X Up to 50 pounds X Up to 100 pounds X Over 100 pounds X Reaching or stretching X Climbing or balancing X Crouching or stooping X Speaking X Hearing X Seeing (with correction) X