Senior Compliance Specialist

FLSA Status: Exempt, Non-Bargaining Unit Position

POSITION SUMMARY: At the direction of the Chief Compliance Officer, the Senior Compliance Specialist will develop, coordinate and support the rapid response Compliance Program functions and activities. These activities are directed toward a primary objective of enabling UW Physicians and CUMG and their Providers to comply with all applicable billing and privacy compliance regulations and reporting of compliance activities and potential concerns for trending review and risk assessment.

ESSENTIAL RESPONSIBILITIES:

Compliance Coordination

• Responsible for managing the rapid response functions of the Compliance Program at the direction of the Chief Compliance Officer. Key operational functions include compliance consultations, focused investigational reviews, risk assessment analysis and effective compliance reporting.
  
• Serves as Compliance Program liaison to (a) Clinical Department Physician Champions and (b) UWP Finance and Claims Processing areas for compliance findings requiring financial repayments.
  
• Liaison with UW Physicians, and CUMG Providers to coordinate compliances activities on those matters related to billing, and compliance.
  
• Contributes to annual compliance work plan and supports the achievement of the Compliance Program goals. Makes adjustments as needed to address reprioritization of Compliance Program activities.

Standards

• Advises the Chief Compliance Officer on matters relating to technical billing, coding, or regulatory requirements for documenting, coding, and billing for health care services.
  
• Is a key part of the leadership of the Compliance Department. Communicates collaboratively with other Department Managers and Leaders. Develops productive working relationships with all levels of management and Compliance Program staff.
  
• Immediately reports regulatory compliance issues, or concerns to the Chief Compliance Officer.
  
• Maintains strict confidentiality of all information obtained from any source in accordance with privacy and disclosure laws and UWP policies.
  
• Consistently demonstrates leadership, integrity, initiative and team-building support. Role models professionalism and commitment to continuous improvement.

Compliance Consultations

• Perform comprehensive research, expert analysis and draft consultation reports on complex issues related to billing compliance for Compliance Officer approval. Consultations to include current regulatory standards and Compliance Program opinion for policy development and/or clinical documentation or billing process changes.
  
• Routinely, at minimum monthly, reviews Compliance information line request responses for consultations, policy clarifications or other Compliance Program response needed to address frequently asked or systemic issues.
  
• Under the direction of the Compliance Officer, queries other academic medical centers, physician practice groups or other source for practice norms and confirmation of consistency in interpretation of standards.
  
• Maintain documentation of consultations on the Compliance web-site as a general resource.
  
• Draft Compliance Program alert notices for timely notice of new regulations, changes in interpretation and/or identified risk concerns.
  
• Participates in the ongoing maintenance and updating of the Compliance Program manual.

Investigatory Reviews

• Performs probe reviews, focused reviews and other special projects as requested by Compliance Officer.
  
• Manages the Investigations work process and maintains files in accordance with retention policy.
  
• Is coordinator for investigation review group. Tracks resolutions of each issue and provides trending reports monthly and as requested.
  
• Develops methodology for investigation reviews that ensures consistency in process.
  
• Is Compliance Program expert for use of UW Medicine risk tracking system. Develops working relationships with system administrators and other key users.

Risk Assessment

• Assists in identifying trends in compliance issues and participates in identifying solutions and system changes to mitigate risk concerns.
  
• Provides data analysis and regulatory and standards research for input to compliance risk assessment impact and priority-setting.
  
• Is Project Lead for managing risk assessment methodology and maintaining documentation and supporting materials.
  
• Keeps current with OIG workplan issues and progress as well as CMS billing compliance initiatives and advises the Chief Compliance Officer accordingly.
  
• Develops and maintains Compliance Program systematic process for annual review of Compliance policies and tracks revisions for appropriate approval. Ensures Compliance web-site has most current policies posted.

Reporting

• Develops, monitors, and maintains statistical reports of Consultation activity for monthly and as requested reporting.
  
• Prepares clear, concise written reports for internal and external reporting purposes. Reviews and edits reports generated by other Compliance Program staff to ensure consistency with quality and professionalism standards.
  
• Represents UW Physicians and CUMG at staff meetings, professional conferences, and with the payor community.
  
• Provides background information and other reports as requested for Compliance committee and task force work.
  
• Periodically reports to Compliance Committees and Leadership Boards and serves on Committees and task forces as requested.  May be Project Lead and/or key facilitator of task force groups including developing group charters, project goals, meeting agendas, records of work plans and communication of group actions, including appropriate escalation of issues.
  
• Maintains tracking and reporting of disclosures, repayments and settlements for overall Compliance Program auditing, monitoring and special review activities.

Training

• Communicates and coordinates identified risk concerns with the Compliance training program, and participates in training as needed.

Supervision

• Manages special project personnel including assigned Compliance staff, contract resources and temporary employees.  Interviews, evaluates, and selects personnel for employment, handles basic supervisory and disciplinary problems, trains new employees, and provides for follow-up necessary in the learning process.  Recommends disciplinary action, when needed, in accordance with UWP human resource policies.
  
• Is Project Manager for Contractors engaged by Compliance to assist with investigation, special projects, risk assessment or other activity.
  
• Develops, and implements review processes, work methods, standards, and job priorities.
  
• Develops, and maintains employee performance criteria.  Provides regular, at least monthly, feedback to individual employees.
  
• Ensures staff maintains, and or pursues professional growth by encouraging their participation in educational programs, professional organizations, and activities to maintain knowledge of current trends, practices, and developments.
  
• Assesses special project Compliance staff competencies and identifies training needs. Develops staff development and training plan as basis for annual budget requests for training support.

Professional Development

• Maintains technical expertise and compliance standards knowledge.
  
• Maintains certification accreditation requirements.
  
• Identifies personal professional growth goals at minimum annually for review with Chief Compliance Officer.

Other

• Performs other job related assignments as requested by the Chief Compliance Officer.

REQUIRED QUALIFICATIONS:

• Bachelor’s degree in business, nursing, or health information management. Equivalent experience of five years, or more in health care management, coding, billing and relevant nursing experience may be substituted for educational requirements. Training in business administration, or in a medical/clinical discipline is preferred.
  
• Professional fee coding certification required. Significant experience in working with current CPT and HCPCS coding nomenclature and rules, ICD-9-CM coding conventions, and clinical documentation standards.
  
• Experience in teaching physicians environments is required.  Experience with both adult and pediatric patient populations preferred.
  
• Minimum two years of experience working directly with physicians on professional fee billing compliance.
  
• In-depth and comprehensive knowledge of regulatory billing, government payer rules and regulations is required.
  
• Ability to work independently to complete a compliance investigation.
  
• Work requires attention to detail and a degree of accuracy.
  
• PC proficiency with Windows based software, and Microsoft Office Suite products in a network environment.
  
• Experience in preparing effective presentations and reports using a variety of software programs (e.g., Visio, Powerpoint and dashboard reports).
  
• Excellent oral, written, and interpersonal communication skills, with the ability to convey a positive and professional image in person, on the telephone, and in written correspondence. Ability to deal calmly but firmly with compliance matters.
  
• Advanced organization and time management skills for managing multiple requests and competing deadlines requiring prioritization and tracking for follow through. Project Management experience desirable.

COMPLIANCE REQUIREMENTS: All management positions require adherence to the UWP Code of Conduct and UWP Billing Compliance Policies and related training requirements. Incumbents must demonstrate knowledge and understanding of the confidentiality of employee information, UWP plans, initiatives, and financial information, and patient privacy rights. Job duties must be performed with minimum access to and use of UWP, employee, and/or patient information. Incumbents are required to engage in active discussion with subordinates on the requirements for reporting of compliance concerns and the company’s commitment to non-retaliation for reporting such concerns. Incumbents must promptly report all compliance concerns.

SELECTION: Selection is based on the candidate meeting the required qualifications, demonstration of related experience and/or education, favorable attainment of references, and the candidate's ability to fulfill the described job responsibilities.

APPLICATION: To apply for this position, please complete this Equal Employment Opportunity Affirmative Action Form. After completing the form you will be provided with further instructions for submitting your cover letter and resume to complete the application process. If you are applying for more than one position, please complete this process for each position.

EQUAL OPPORTUNITY EMPLOYER