Position Summary:

Senior Compliance Audit Specialist reports to the VP of Compliance and will assist with and support the compliance program activities of Sonic Healthcare USA, WSW Division. The Compliance Audit Specialist will support the compliance department through auditing/monitoring, planning, education, assessment, and other compliance program functions including any existing compliance activities, with a particular focus on clinical/billing compliance and data analytics. They will also assist with such activities as policy and procedure development and maintenance, hotline monitoring and compliance complaint investigations, and Compliance and HIPAA training throughout the company.

Principal Responsibilities:

• Auditing and Monitoring
  • Perform annual compliance department risk assessment to develop annual department work plan
  • Design data tracking systems to detect, monitor, audit and track data to aid in identifying risk areas and correct non-compliances and monitor compliant solutions
  • Prepare compliance audit data by compiling and analyzing internal and external data
  • Manage audits of federal and state exclusion sanctions lists
  • Monitor annual and new hire compliance and HIPAA training
  • Review and audit revenue billing cycle functions including but not limited to, ABNs, standing orders, charge master, and denials
  • Audit findings, communicate to and recommend corrective strategies
  • Establish and refine, as needed, systems to effectively audit and monitor WSW Division compliance policies.
    
• Billing Compliance
  • Build regularly scheduled audit mechanisms in the XiFin environment
  • Manage necessary data reports to support investigations
  • Review CCI edits, MUEs and LCD/NCDs that apply to WSW Billing regularly
  • Manage Better Business Bureau Billing complaints
  • Act as compliance liaison between XiFin and WSW division
  • Develop, organize and maintain WSW division Billing policies and procedure
    
• Compliance Inspections of WSW laboratories and phlebotomy locations
  • Use established inspection tools to identify non-compliances and prepare reports
  • Provide guidance for corrective action, track completion and monitor success.
  • Participate in employee Compliance and HIPAA education
    
• Other compliance department responsibilities
  • Communicate, promote and exemplify the Sonic Values, Compliance Plan and Standard of Conduct to employees in a useful and understandable format
  • Provide guidance about regulations affecting laboratories to staff
  • Remain current with all applicable laws, rules and regulations
  • Continuous self-reeducation regarding current and updated regulations using sources which include Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Department of Insurance and local carriers in each state.
  • Participate in compliance updates and education at manager meetings, phlebotomy meetings, new sales training, QI Ops calls, etc.
  • Medicare and Medicaid Enrollment

Education:

• Bachelor's Degree; preferred concentrations: Chemistry, Biology or Medical Technician, Healthcare Compliance, Health Sciences, Healthcare Data Science, and Healthcare Administration.
• Certification in Healthcare Compliance and/or Certification in Medical Coding and Billing

Experience:

• Minimum of three years medical billing experience, emphasis on laboratory billing
• Minimum of three years corporate compliance in the healthcare sector
• Minimum of three years in laboratory training and/or experience in a medical laboratory
• Experience with XiFin, FIN, Misys software systems

Skills:

• Good knowledge of healthcare fraud, waste and abuse regulations specific to laboratory compliance
• Good knowledge of Medicare laws, billing regulations, CCI edits, MUEs, LCDs/NCDs
• Good knowledge of Laboratory billing in terms of Managed Care, Capitation, private and government payors
• Scope and Root cause analysis and Corrective Action
• Auditing and monitoring to proactively detect issues and mitigate risk
• Highly developed analytical skills for both qualitative and quantitative data
• Ability to plan and lead projects following tight deadlines
• Demonstrates a high-level of attention to detail and accuracy
• Excellent communication skills - strong verbal and written skills
• Ability to exercise initiative, discretion, and judgement
• Ability to provide sound advice and guidance to managers and employees in supporting governance and compliance matters

Travel:

• Expected Travel - one week a month