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UnityPoint Health Compliance Specialist in Urbandale, Iowa

Compliance Specialist- HME Department

Unity Point at Home

Monday- Friday, 8a-5p

Full-Time Benefits, 40 Hours/ Week

Develops and maintains oversight of both internal and external auditing to mitigate regulatory and payer risks. Uses

results of audits to collaborate with leadership to develop performance improve plans. Maintains policies, procedures

and forms to ensure they meet all necessary regulations and accreditation standards. Ensures that all necessary

steps are taken to maintain accreditation. Main contact for other HME risk/compliance areas including, interpretation

of regulations, auditing projects, root cause analysis work, and applicable UPAH internal committee functions.

Compliance/Audits

  • Develop, implement, and maintain oversight of a coordinated and comprehensive pre/post pay audit process.

  • Coordinates audit requests and ensures necessary timelines are met

  • Access patient records in multiple software systems, research conflicting information and facilitate the procurement of appropriate documentation to update UPAH records to support reimbursement.

  • Recognize, troubleshoot and notify leadership, as appropriate, problems or issues that would result in process breakdown leading to inefficiencies and improper reimbursement.

  • Conduct mock surveys, audits, and education as requested or required.

  • Develop and update tools to alert operations in a timely manner of necessary follow up needed on specific accounts or payers

  • Communicate with management regularly to review issues and opportunities for improvement, complete root cause analysis, and monitor and trend HME related event and complaint data.

  • Compile audit results and present to performance improvement team and internal compliance committee to drive awareness and action plans identified in audits or industry news to ensure that documentation is obtained for services delivered and high risk areas are audited/monitored appropriately and proactively.

  • Identify and assess compliance risks and devise strategies for risk mitigation.

  • Assist internal audit with coordinating/conducting audit project completion, responses, and action plans.

Policies and Procedures

  • Develop and provide oversight on all HME processes to ensure they meet all regulatory requirements

  • Annually review and modify processes and policies and provide suggested changes/additions when necessary

  • Attend internal forms committee as HME representative and create new and edit existing HME forms to ensure they meet industry regulations, are available to all sites, and are being used consistently.

  • Coordinate accreditation visits and work with all sites to assist in both preparation and post-survey response

  • Completes accreditation self-studies prior to site visits

  • Develop tools to ensure sites are prepared for accreditation based on risk analysis

  • Conducts mock surveys to ensure agency meets all regulatory requirements including CHAP, FDA and CMS

  • Collaborate with management team to identify and prioritize performance improvement initiatives and then monitor results and necessary process modifications to drive optimal operational results

Basic UPH Performance Criteria

  • Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

  • Demonstrates ability to meet business needs of department with regular, reliable attendance.

  • Employee maintains current licenses and/or certifications required for the position.

  • Practices and reflects knowledge of HIPAA, JCAHO, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.

  • Completes all annual education and competency requirements within the calendar year.

  • Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

Education:

  • Bachelor’s degree in healthcare related field or equivalent combination of education and experience.

Experience:

  • Five years healthcare experience, including customer service/billing operations

  • Proficiency in computer systems and applications.(e.g., Word, Excel)

  • Previous experience with planning, organizing and delegating.

  • Previous experience in development of policies and procedures

Knowledge/Skills/Abilities:

  • Knowledge and experience with CQI processes.

  • Knowledge of industry specific rules and regulations

  • Communication-written & verbal

  • Decision making

  • Managing priorities/deadlines

  • Planning and organizing skills

  • Decision making

  • Project management

  • Interpersonal skills

  • Teamwork

  • Detail oriented

  • Ability to work independently and possess time-management skills

  • Ability to understand and apply guidelines, policies and procedures.

Requisition ID: 2020-80425

Street: 11333 Aurora Ave

Name: 9400 UnityPoint at Home Affiliate

FTE (Numeric Only; Ex. 0.01): 1.0

FLSA Status: Exempt

External Company URL: http://www.unitypoint.org

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