Job Description

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

Primary Purpose

The Senior Compliance Investigations Consultant is responsible for effectively carrying out investigations of internal and external reports of compliance-related allegations.

Minimum Specifications

Education

• A bachelor’s degree is required, master’s degree preferred.

Experience

• Must have six (6) years' experience in healthcare compliance, preferably with a large, multi-faceted healthcare company or academic medical center. Experience with compliance investigations, confidential communications, attorney-directed reviews, conflicts of interest, employee relations and other healthcare compliance-related activities required.
• Prior experience in revenue cycle operations preferred, such as coding, billing, collections, account reconciliation or other patient financial services functions.

Equivalent Education and/or Experience

• An equivalent combination of experience and certification may be accepted in lieu of education only.

Certification/Registration/Licensure

• Certification in a healthcare compliance-related specialty is required. Must be currently certified and in good standing with one of the following:
  • Certified in Healthcare Compliance (CHC)
  • Certified Compliance and Ethics Professional (CCEP)
  • Certified in Healthcare Privacy Compliance (CHPC)
  • Certified in Healthcare Research Compliance (CHRC)
  • Certified Professional Compliance Officer (CPCO)
  • Certified Professional Coder (CPC)
  • Certified Outpatient Coder (COC)
  • Certified Inpatient Coder (CIC)
  • Certified Coding Specialist (CCS)
• Renewals must be submitted no later than 7 calendar days after the current expiration date.

Skills or Special Abilities

• Detailed knowledge of compliance program requirements for hospitals and academic health systems.
• Demonstrates the ability to evaluate healthcare compliance issues and make appropriate recommendations.
• Adept at developing and executing all phases of a plan of audit and compliance investigations, including but not limited, to review and analysis of data, information, and records, conducting reviews, and drafting findings and conclusions.
• Able to write clear, detailed reports summarizing the scope of a purpose of audits and compliance investigations, conclusions or findings and the application of the compliance risk analysis and corrective action recommendations.
• Strong oral and written communication skills and interpersonal skills. Able to communicate thoughts, ideas, information and messages with clear language, style, organization, and format appropriate to the subject matter, purpose and audience.
• An active listener with the exercise of sound professional judgement.
• Possesses excellent critical thinking skills, including the ability to identify a problem, determine the root cause, communicate findings, and participate in the development of the solution.
• Detailed-oriented with strong organizational and time management skills and the ability to effectively prioritize daily tasks.
• Capable of managing difficult conversations with sensitivity and the ability to respond to confidential information with objectivity and discretion.
• Demonstrates a high degree of integrity and practice ethical standards.

Responsibilities

1. Independently and objectively conducts investigations of compliance and ethics related matters across all business areas.
2. Processes and evaluates allegations to facilitate decisions related to the scope and execution of an investigation.
3. Research and reviews suspected activities to develop factual evidence.
4. Identifies, collects, and analyzes factual evidence to establish clear and concise findings to facilitate decision-making.
5. Conducts in-person interviews and documents discussions in a reliable and consistent fashion.
6. Drafts comprehensive investigations reports that clearly and concisely summarizes the nature of concern and substantiates or negates allegations of misconduct or non-compliance.
7. Informs leadership of potential or actual allegations and recommends corrective action or improvement.
8. Assists with routine administrative and technical aspects of investigations.
9. Works effectively with the Office of Talent Management and the Legal Department.
10. Assists with the maintenance of the sanction screening database tool, coordinates scheduled searches for excluding individuals, assists with the resolution process and summarizes findings.
11. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines pertaining to healthcare compliance and ethics. Seeks advice and guidance as needed to ensure proper understanding.
12. Serves as an advocate for compliance and ethics and champions the importance of compliance with laws, regulations, policies, and procedures in an effort to build a culture of compliance and integrity.
13. Consistently serves as a resource for Parkland employees, developing collaborative working relationships and providing timely advice related to compliance and ethics matters.
14. Stays abreast of the latest developments, advancements, and trends in the field of data management and compliance and ethics by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
15. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.

Job Accountabilities

1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.

Job Tags

Similar Jobs