Compliance Specialist
LifeCare Home Health Family
full-time
Posted on:
Location Type: Remote
Location: United States
Visit company websiteExplore more
About the role
- Responsible for assisting with the development and implementation of the compliance audit program to ensure regulatory adherence, risk mitigation and operational integrity.
- Ensures that Lifecare Home Health Family complies with federal and state laws and regulations and internal policies by identifying potential risks and working cross-functionally to implement corrective actions.
- Lead risk assessments, internal audits and compliance investigations while collaborating with leadership to mitigate risks and strengthen internal controls.
- Responds timely and accurately to governmental audits for hospice and homecare.
- Prepares and tracks appeals processes.
- Assist with the development and implementation of a comprehensive compliance audit program tailored to meet the requirements of CMS, Medicaid, Medicare, Medicare Advantage plans, other government payors, private insurers, the Office of Inspector General (OIG) and the Department of Justice (DOJ).
- Develop audit frameworks, methodologies and policies that align with regulatory requirements and best practices within healthcare.
- Ensure audits are thoroughly documented and findings are reported with corrective action recommendations.
- Assist with the establishment of a continuous monitoring system for compliance risks and policy effectiveness.
- Conduct risk-based audits to assess the effectiveness of internal controls and adherence to internal policies.
- Develop risk mitigation strategies and ensure corrective action plans are implemented.
- Collaborate with departments such as Legal, Human Resources, Finance, IT, Quality, Billing and Coding to enhance internal controls and address and remediate compliance risks.
- Provide guidance to operational teams on improving processes to ensure compliance with federal and state laws and regulations and internal policies.
- Monitor emerging regulatory trends and enforcement actions to proactively address potential risks.
- Draft and update audit related policies, procedures and guidelines.
- Provide guidance on internal controls, regulatory requirements and audit best practices.
- Develop and deliver compliance audit training and education to employees on regulatory requirements, compliance best practices and audit procedures.
- Oversee internal investigations related to risk assessment and/or audit findings, conducting root cause analysis to identify trends or patterns of non-compliance.
- Develop corrective action plans (CAPs) and track their implementation.
- Ensure confidentiality and integrity in all investigations and reporting.
- Serve as a trusted advisor to the Chief Compliance Officer, executive team and leadership.
- Foster a culture of compliant and ethical behavior across the organization.
- Collaborate with key stakeholders.
- Support external auditors and regulatory agencies during compliance reviews and investigations.
Requirements
- Extensive knowledge of hospice Local Coverage Determinations (LCDs)
- 2+ years of compliance auditing, internal audit or regulatory compliance experience.
- Extensive knowledge of audit methodologies, internal controls and risk assessments.
- Strong understanding of healthcare fraud, waste, and abuse prevention, coding compliance, and billing practices within the context of hospice care.
- Experience in healthcare, finance, billing, coding, compliance and government regulations.
- Ability to build relationships with internal and external stakeholders, including leadership, clinical teams, providers, payers, and regulatory bodies.
- At least one of the preferred certifications or the ability to obtain certification within 1 year of employment is required.
- Additional certifications in healthcare compliance, law, privacy, data security, or information management are a plus.
- Experience working collaboratively with regulatory agencies, auditors, and healthcare providers to ensure compliance with hospice requirements.
- Strong analytical and problem-solving skills, with the ability to identify compliance risks, assess organizational performance, and develop actionable solutions.
- Ability to pass DHS background study.
- Associate’s degree in Business Administration, Finance, Accounting, Healthcare Administration, or a related field.
- Excellent verbal and written communication skills with the ability to clearly communicate complex compliance issues to senior executives and staff members at all levels.
- Preferred Certifications:
- o Certified in Healthcare Compliance (CHC)
- o Certified Internal Specialist (CIA)
- o Certified Billing and Coding Specialist (CBCS)
- o Certified Professional Coder (CPC)
- o Certified Professional Medical Specialist (CPMA)
- o Certified Compliance and Ethics Professional (CCEP)
Benefits
- Work Where You Matter!
- Compassionate care focused on patient’s quality of life
- Empowering patients to make the most of their time with dignity, comfort, and respect
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
compliance auditinginternal auditregulatory complianceaudit methodologiesinternal controlsrisk assessmentshealthcare fraud preventioncoding compliancebilling practicescontinuous monitoring
Soft Skills
relationship buildinganalytical skillsproblem-solving skillscommunication skillscollaborationleadershipguidancetrustworthinessethical behaviortraining and education
Certifications
Certified in Healthcare Compliance (CHC)Certified Internal Specialist (CIA)Certified Billing and Coding Specialist (CBCS)Certified Professional Coder (CPC)Certified Professional Medical Specialist (CPMA)Certified Compliance and Ethics Professional (CCEP)