Compliance Specialist II at Grant County, WA

About the Department

Compliance Specialist II works with clinical staff to educate and monitor their compliance to coding and reimbursement standards.  This position develops work plans to assist clinical staff in meeting the compliance standards of the agency.  This position performs compliance audits and meets with the staff to review.  This position is required to know and understand the separate regulations that govern behavioral health and developmental disabilities programs in order to complete the proper paperwork, follow the correct disclosure laws, and ensure efficient assistance to Grant County citizens.   This position must maintain a very high standard for professionalism, customer service, and confidentiality.  This position is expected to work a minimum of 40 hours per week. The hours/days will be set by the supervisor and designed to accommodate the Agency’s needs.

Position Duties

• Develops and Demonstrates a comprehensive understanding of all WAC, RCW, CFR, and contracts to ensure compliance.
• Researches all WAC, RCW, CFR, HIPAA and HITECH rulings in order to develop and maintain a comprehensive compliance plan for each of the programs.
• Develops, and then maintains, multiple compliance plans for the agency which involves creating and revising policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical, or improper conduct.
• Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.  Reports aggregated data to management and leadership teams.
• Identifies potential areas of compliance vulnerability and risk.  Provides guidance on how to ensure compliance on a consistent basis.
• Works with managers and Human Resources in implementing Performance Improvement Plans, or work plans, for resolution of problematic areas.
• Implements and maintains an effective training program for new employees related to agency policies and procedures and the Compliance Plan specific to their programs.  Provides or ensures provision of annual refresher training for all current employees.
• Ability to read, comprehend and implement new laws, regulations, and policy changes at federal and state levels and relate them to our agency level.   Distribute and train on the information to appropriate directors, managers, and service providers.
• Monitors other websites, discussion groups and social media for information pertinent to the business activities of Renew.
• Review quarterly and annual CPT, HCPCS, ICD-10 code changes prior to the effective date.  Prepare detailed summaries and provide training as appropriate to service providers and managers.
• Assures all documentation and records meet Washington Administrative Code (WAC), Revised Code of Washington (RCW), Code of Federal Regulations (CFR), regional and state contracts, and all other applicable Agency requirements.
• Serves on the HIPAA Committee and reviews all breaches of information providing recommendations on courses of action related to the breach.
• Conducts independent reviews of clinical documentation to ensure that compliance issues/concerns within the agency are being appropriately identified, evaluated, investigated and resolved.
• Reviews all failed audits which are conducted by the Compliance Specialist I and meets with the staff and manager for retraining specific to the areas of concern.

Minimum Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Any combination of education and experience may be substituted as long as it provides the desired skills, knowledge and abilities to perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

1. High School Diploma/GED
2. Five (5) years’ experience in medical business activities
3. Comprehensive knowledge of the conventions of CPT and ICD-9 coding and HCPC’s
4. Knowledge of medical coding compliance and the State and Federal regulations pertaining to coding and payment of medical services;
5. Personal computer operations experience;
6. Background Check: Must have an acceptable background report, at time of hire and every three years afterward; 
7. Driving Abstract: Must have an acceptable driving report; and
8. Certified Professional Coder certification: Hold and maintain.

1. Bachelor’s Degree in business or health information management;
2. Two years of experience conducting provider education and audits; 
3. Thorough knowledge of Medicare/Medicaid and third party coding requirements;
4. Thorough knowledge of data auditing and compliance;
5. Hold and maintain Certified Compliance Professional certification;
6. Hold and maintain Certified Professional Medical Auditor certification; or
7. Knowledge of County and Agency policies and procedures.
8. These skills and abilities typically are acquired through a combination of experience and training. Experience may be substituted for education.

Other Qualifications

Work Conditions: Work is primarily performed in an office setting but may include any of the Renew offices as well as various work locations, including community locations and/or trainings. Because of the variance of location, the employee may be exposed to varying temperature, odors or vapors, sub-sanitary environments (pets, second-hand smoke), and weather.  This position requires travel to attend local, state and national meetings as applicable.

Physical Abilities: The physical abilities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  While performing the duties of this job, the employee is regularly required to walk, sit, write, hear, speak and lift up to 50 lbs. of unequal weight.  Manual dexterity and accuracy are required for performing essential duties. Specific vision abilities required by this job include close and distance vision, peripheral, depth perception.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.