Job Functions, Duties, Responsibilities And Position Qualifications

Position Summary:The Compliance Audit Specialist reports to the VP of Compliance and will assist with and support the compliance program activities of Clinical Pathology Laboratories (CPL). The Compliance Audit Specialist will support the compliance department through auditing/monitoring, planning, education, assessment, and other compliance program functions including any existing compliance activities, with a particular focus on clinical/billing compliance and data analytics. They will also assist with such activities as policy and procedure development and maintenance, hotline monitoring and compliance complaint investigations, and training throughout the company.

Principal Responsibilities

Auditing and Monitoring

Perform annual compliance department risk assessment to develop annual department work plan
Design data tracking systems to detect, monitor, audit and track data to aid in identifying risk areas and correct non compliances
Prepare compliance audit data by compiling and analyzing internal and external data
Manage audits of federal and state exclusion sanctions lists for employees, vendors and clients
Monitor annual and new hire compliance and HIPAA training
Review and audit revenue billing cycle functions including but not limited to, ABNs, standing orders, charge master, and denials
audit findings, communicate to and recommend corrective strategies to agency
Establish and refine, as needed, systems to effectively audit and monitor CPL compliance with rules and regulations applying to laboratory operations.

Compliance Inspections of CPL laboratories and phlebotomy locations

Using established inspection tools to identify non-compliances and prepare written report
Provide guidance for corrective action, track completion and monitor success. Participate in employee education

Other compliance department responsibilities

Communicate, promote and exemplify the Compliance Plan and Standard of Conduct to employees in a useful and understandable format
Provide guidance about regulations affecting laboratories to staff when requested
Continuous reeducation regarding current and updated regulations using sources which include Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Board of Medical Examiners, the State Department of Insurance and local carriers in each state.
Participate in compliance updates and education at manager meetings, phlebotomy meetings, new sales training, QI Ops calls, etc.
Remain current with all applicable laws, rules and regulations
Medicare and Medicaid Enrollment

Education:Bachelor’s Degree; preferred concentrations; chemical, biological or medical technician, healthcare compliance, health sciences, healthcare data science, and healthcare administration.

Preferred: Certification in Healthcare Compliance and/or Certification in Medical Coding and Billing

Experience:Minimum of three years in laboratory training and/or experience in a medical laboratory

Skills

Good knowledge of laboratory medicine at both the technical and administrative levels
Highly developed analytical skills for both qualitative and quantitative data
Ability to plan and lead projects following tight deadlines
Demonstrates a high-level of attention to detail and accuracy
Excellent communication skills - strong verbal and written skills
Ability to exercise initiative, discretion, and judgement
Ability to provide sound advice and guidance to managers and employees in supporting governance and compliance matters

Reporting Relationship:Reports to the VP of Compliance

Physical Requirements:Requires light to medium lifting and carrying of objects weighing up to 50 pounds. Requires manipulation of tools, objects, and equipment using the following physical motions: pushing, pulling, lifting, reaching above shoulder height, grasping with both hands, pinching with thumb and forefinger, twisting with hand and wrist, climbing under, lifting up, lifting down, and reaching under. Routinely requires coordination of two or more physical operations. Routinely requires visual discrimination of color, size, shape, and motility.

Environmental Demands:Works in temperature controlled environment with constant exposure to biological and chemical hazards. May be required to operate fire and safety equipment or follow other safety procedures in an emergency situation. May be required to work with time constraints and in crisis situations.

Scheduled Weekly Hours

40

Work Shift

Job Category:

Administration

Company

Clinical Pathology Laboratories, Inc.

Sonic Healthcare USA is an equal opportunity employer that celebrates diversity and is committed to an inclusive workplace for all employees. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, age, national origin, disability, genetics, veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.