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    ps clinical compliance officer - Salt Lake City, UT , USA, United States - University of Utah

    University of Utah
    University of Utah Salt Lake City, UT , USA, United States

    1 week ago

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    Description
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    Announcement

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    Open Date 03/05/2024 Requisition Number PRN37888B Job Title PS Clinical Compliance Officer Working Title Regulatory Compliance Administrator Job Grade G FLSA Code Professional Patient Sensitive Job Code? No Standard Hours per Week 40 Full Time or Part Time? Full Time Shift Day Work Schedule Summary

    This position has the possibility of remote work

    VP Area U of U Health - Academics Department COMPLIANCE SERVICES Location Campus City Salt Lake City, UT Type of Recruitment External Posting Pay Rate Range $60,700 -$95,000 DOE Close Date Open Until Filled Yes Job Summary


    The Regulatory Compliance Administrator collaborates with providers, managers, and staff to assist departments, clinics, and/or service lines in implementing, coordinating, and monitoring compliance practices.

    This incumbent is responsible for conducting medical necessity audits by reviewing clinical practice standards and documentation.

    The incumbent will conduct and respond to audits and projects related to regulatory and payment integrity to ensure accurate and timely responses to governmental contractors.

    In addition to the clinical expertise needed for the medical necessity reviews, the incumbent will perform scheduled and unscheduled regulatory and payment integrity audits, develop and standardize policies and procedures, training and education, compliance investigations, and reporting to ensure compliance with University, State, and Federal guidelines.

    The incumbent must be highly skilled in time management and possess strong communication skills.

    The incumbent will work with their team to evaluate and review individual skills and knowledge level and assign tasks accordingly.

    Must be able to provide mentoring to supporting roles within the team.

    This position is not responsible for providing patient care. This position has the possibility of remote work.

    Responsibilities

    Essential Functions


    • Maintains current knowledge regarding federal and state guidance, organizational needs, and regulations.
    • This position prioritizes governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel.
    • Reviews documentation for medical necessity and utilizes industry standard tools such as InterQual or Milliman.
    • Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.
    • Assists the University in preparing and completing regulatory audits by developing, monitoring, and updating quality controls and recommending actions to maintain compliance.
    • Oversees, coordinates, and conducts audits/investigations to ensure compliance with University, State, and Federal guidelines.
    • Analyzes and documents compliance processes. Recommends enhancements to policies and procedures for compliance review.
    • Designs and implements training and education programs to enhance compliance awareness.
    • Serves as an expert resource in compliance issue resolution.


    This job description has been designed to indicate the general nature and level of work performed by employees within this classification.

    It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job

    Work Environment and Level of Frequency typically required


    Nearly Continuously:
    Office environment.

    Physical Requirements and Level of Frequency that may be required

    Nearly Continuously:
    Sitting, hearing, listening, talking.

    Often:
    Repetitive hand motion (such as typing), walking.


    Seldom:
    Bending, reaching overhead.

    Minimum Qualifications


    • Three to five years of clinical experience in a patient care capacity is required.
    • Patient care experience may be substituted with equivalent years of experience in medical necessity review.
    • Current medical licensure through DOPL (or equivalent state agency) such as, but not limited to: RN, BSN, NP, PA, etc preferred.
    • Must be proficient with word processing, spreadsheet, and related computer applications and have exemplary human relations and effective communication skills.
    • Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities.
    • Department may require coding certification (CPC, ACS, CCS-P/H, RHIA, or RHIT).


    Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

    Preferences


    • Knowledge of utilization review and quality assurance procedures, as well as experience with InterQual or Milliman and Case Management procedures of medical necessity auditing
    • Bachelor's Degree in Health Care Administration, Business Administration, or a related field, or the equivalent
    • Knowledge of medical auditing, Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD-10, CPT, HCPCS, DRG coding
    • Coding certification (CPC, CPC-H, ACS, CCS-P/H, RHIA)
    • If not current, must be willing to obtain within the first six months of employment
    • Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA)
    • If not current, must be willing to obtain within the first six months of employment
    Type Benefited Staff Special Instructions Summary Additional Information

    The University is a participating employer with Utah Retirement Systems (URS).

    Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work).

    Contact Human Resources at for information.

    Individuals who previously retired and are receiving monthly retirement benefits from URS are subject to URS' post-retirement rules and restrictions.

    Please contact Utah Retirement Systems at or or University Human Resource Management at if you have questions regarding the post-retirement rules.

    This position may require the successful completion of a criminal background check and/or drug screen.


    The University of Utah values candidates who have experience working in settings with students and patients from all backgrounds and possess a strong commitment to improving access to higher education and quality healthcare for historically underrepresented students and patients.

    All qualified individuals are strongly encouraged to apply. Veterans' preference is extended to qualified applicants, upon request and consistent with University policy and Utah state law. Upon request, reasonable accommodations in the application process will be provided to individuals with disabilities.


    The University of Utah is an Affirmative Action/Equal Opportunity employer and does not discriminate based upon race, ethnicity, color, religion, national origin, age, disability, sex, sexual orientation, gender, gender identity, gender expression, pregnancy, pregnancy-related conditions, genetic information, or protected veteran's status.

    The University does not discriminate on the basis of sex in the education program or activity that it operates, as required by Title IX and 34 CFR part 106.

    The requirement not to discriminate in education programs or activities extends to admission and employment.

    Inquiries about the application of Title IX and its regulations may be referred to the Title IX Coordinator, to the Department of Education, Office for Civil Rights, or both.


    To request a reasonable accommodation for a disability or if you or someone you know has experienced discrimination or sexual misconduct including sexual harassment, you may contact the Director/Title IX Coordinator in the Office of Equal Opportunity and Affirmative Action (OEO/AA).

    More information, including the Director/Title IX Coordinator's office address, electronic mail address, and telephone number can be located at:

    Online reports may be submitted at

    This report includes statistics about criminal offenses, hate crimes, arrests and referrals for disciplinary action, and Violence Against Women Act offenses.

    They also provide information about safety and security-related services offered by the University of Utah.

    A paper copy can be obtained by request at the Department of Public Safety located at 1658 East 500 South.

    Posting Specific Questions

    Required fields are indicated with an asterisk (*).


    • How many years of related work experience do you have?
    • None
    • Less than 3 years
    • 3 years or more, but less than 5 years
    • 5 years or more, but less than 7 years
    • 7 years or more, but less than 9 years
    • 9 years or more
    • Do you have a current clinical license or patient care experience equivalency? (See qualifications for more details.)
    • Yes
    • No
    • Indicate your level of knowledge of medical auditing, Federal healthcare program policies including Medicare Parts A and B, and ICD-9, CPT, HCPCS, DRG coding:
    • None
    • Minimal
    • Moderate
    • Extensive
    Applicant Documents

    Required Documents


    • Resume
    Optional Documents


    • Cover Letter
    • Appropriate discharge document (such as a DD-21- Member Copy 4) - Veteran Only - Call
    • Addendum to the University of Utah - Veteran Only - Call after submission
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