Lancaster General Hospital
This position is located in Lancaster, PA
HOURS: Full-Time; 8:30am-5:00pm Monday-Friday; no holidays or weekends.
ATTENTION: Please be aware that, if you are an external applicant, you may need to complete an online assessment as part of the hiring process. This assessment will be sent to the e-mail address that you included in your application. Please note: Some e-mail accounts may receive the assessment e-mail in their junk/spam e-mail. This assessment must be completed within 5 days of receiving it. For more information regarding the assessment, please click HERE.
POSITION SUMMARY: The Compliance Analyst is responsible for supporting the Compliance Officer, Compliance Manager and/or designee in reviewing, promoting, and evaluating regulatory and other compliance related issues throughout Lancaster General Health. The Compliance Analyst works in accordance with the LG Health Compliance Program. The Compliance Analyst is able to respond to and determine compliance with a multitude of external forces influencing the entire enterprise, including Health Reform regulation, CMS rules and regulations, State regulations and commercial payer requirements. The Compliance Analyst serves as a role model for compliant and ethical behavior consistent with the mission, vision and values of LG Health.
ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:
- Assists the Compliance Manager in monitoring federal, state, and other regulations and guidelines, trade publications, code changes, and determines potential risk areas and if and how they apply within Lancaster General Health.
- Implements compliance department initiatives such as the annual Conflict of Interest Disclosure project and Sanction Checking.
- Identifies risk area or areas of vulnerability within the organization, determines the root cause(s), and suggests solutions by requesting reports, analyzing data, and performing risk assessments. Raises issues of concern to the Compliance Manager or other appropriate resource in order to validate and remediate problems.
- Summarizes regulations, coding and billing changes and communicates them both in writing and verbally, as applicable, to the compliance department, physicians and others.
- Performs research and presents findings in a timely, well-organized fashion.
- Following Compliance Department protocols and annual work plan, performs audits and reviews on regulatory issues, and performs inpatient and outpatient coding and billing audits.
- Pursues problems or potential problems until full resolution, requesting assistance and direction from the Compliance Manager or designee.
- Prepares audit reports for management according to Compliance Department protocols, highlighting deficiencies and recommending corrective action. Evaluates responses to audit report findings and recommendations to determine reasonableness and suggests follow-up actions. Discusses findings with appropriate management and physicians.
- Initiates change and process improvement by working with various departments and staff members. Assists management with various coding/billing issues at any Lancaster General entity.
- Assures that policies and procedures are in place with respect to coding, billing and other areas of compliance and determines whether they are followed.
- Assists in the development of policies and procedures.
- Promotes system-wide understanding of compliance, performs training and education as required.
- Participates in external audits coming from CMS, RACs, MACs, Commercial Payers and so forth. Identities patterns in denials and works with appropriate parties to correct errors, and mitigate future errors.
Posted on 12/12/2019
- Bachelor’s degree required, preferably in a health care related field such as Health Information Management, Health Administration, or Nursing (BSN) or equivalent experience is required.
- Must hold current coding certificate - Registered Health Information Administrator (RHIA), Hospital coding certificate (CCS), other coding certificates considered (e.g. CCS-P, CPC, CPC-H, CPMA).
- 2-4 years of practical experience in health care regulation is required.
- Extensive knowledge of various coding and reimbursement systems with at least three (3) years of coding experience is required,
- Ability to affect change while maintaining positive relationships.
- Knowledge of federal, state and payer specific regulations and policies pertaining to documentation, coding and billing.
- Highly developed analytical and organizational skills; excellent written and verbal communication skills and the ability to articulate difficult concepts in an understandable manner.
- Ability to present compliance related information in various settings.
- Ability to perform internet research.
- Microsoft Word, Excel, PowerPoint and Outlook.
- Ability to navigate through difficult situations.
- Clinical background and knowledge acquired by serving in a CMA, LPN, or RN role preferred.