Compliance Audit Nurse

Job Description

Job Description

Salary

SUMMARY:

Establishes appropriate internal controls related to asset protection and insures throughout the organization: adherence to compliance plans; Medicare regulation; medical record audits; HIPAA privacy compliance

Primary Responsibilities

• Conducts compliance audits including, but not limited to, random chart audits, in accordance with established criteria; ensures proper controls are in place and effective
• Develops and ensures annual compliance training is conducted for physicians and staff
• Responds appropriately to violations of Compliance Plan and brings compliance issues to attention of Executive Administrator, Managing Partner, or outside consultant as necessary
• Works with Compliance Committee to identify organizations compliance risks, develops compliance assessment plan at least annually, ensures compliance assessment plan is followed and that corrective action is taken when indicated
• Reports quarterly to the Compliance Committee and Executive Committee on the operation and effectiveness of the Compliance Plan
• Manages and oversees compliance with HIPAA regulations including the oversight of Business Associate Agreements; acts as a resource for Medicare and HIPAA regulations, and consequences of non-compliance to both
• Develops, implements, maintains, and monitors the Compliance Program policies, the Code of Conduct, the Notice of Privacy Practices, and HIPAA Privacy and Security policies
• Oversees and manages pay-for-performance and Meaningful Use programs including MIPS
• Establishes appropriate internal controls
• Adheres to and supports the Compliance Plan policies, procedures, goals, and intent.
• Provides Committee support as needed.
• Reports incidents in a timely manner and within 24 hours.
• Participates in various personnel actions including but not limited compliance training for professional staff development.
• Adheres to the Clinics Policy and Procedures and the Code of Conduct.
• Maintains a flexible work schedule to accommodate any urgent compliance violation and/or complaint
• Assists with the management of daily operations with respect to participation in Value-Based Care Programs including, but not limited to providing training and resources as necessary to physicians and staff.
• Performs other related duties assigned and incidental to the work described herein.
  
  

Specific Areas Of Responsibilities

Intradepartmental

• Participates in Clinic committees, provides input and ideas to improve Clinic services and operations
• Develops a working relationship with all Physicians, Clinic personnel, and Managers to ensure overall Clinic standards are met. Education, Experience, and Knowledge

• BSN Graduate of an approved school of Registered Professional Nursing (Masters degree preferred)
• Unrestricted license /compact license to practice in the State of Texas
  
  

• Minimum of five (5) years of experience in healthcare compliance and/or risk management.
• EPIC experience
  
  

• Skills and Abilities
• Must demonstrate excellent interpersonal and organizational skills.
• Must have excellent communication skills, including written, verbal, listening, and telephone etiquette
• Strong attention to detail and statistical analysis skills
• Must demonstrate excellent customer service and customer satisfaction skills.
• Able to effectively coordinate multiple projects.
• Must be able to demonstrate solid training skills
• Uses analytical skills for troubleshooting and problem solving.
• Excellent computer skills PC, MS office including data entry in RIS scheduling.