Senior Compliance Specialist

 
Position: Senior Compliance Specialist

Job ID: 152071

Location: US-TX-Bellaire

Department: Controls & Compliance

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 13,000 dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

Summary:

We are looking for a Senior Compliance Specialist – someone who works well in a fast-paced setting. In this position, you will independently and cooperatively plan and manage audits, reviews, investigations and projects to ensure compliance with our hospital’s policies, procedures, state and federal rules, regulations and statutes. You will identify risks by conducting ongoing risk assessments for the hospital and document and report the risk(s) to senior management. You’ll also develop training modules/courses to ensure personnel are appropriately trained in their role for our Corporate Compliance Program. You’ll also update leadership on regulatory changes related to corporate compliance and maintain Compliance Program documentation and databases.    

Think you’ve got what it takes?



Responsibilities :

  • Conducts and manages compliance audits, reviews, projects or investigations
  • Ensures that written reports and correspondence are organized, accurate, appropriate in content, professional in appearance and appropriately convey the reported issue(s)
  • Writes audit report and/or audit memoranda and/or project report in a timely manner as observed by the Assistant Director
  • Schedules, prepares for and attends exit conference to discuss audit/project findings, area(s) of risk, identified issues and proposed recommendations for change
  • Conducts compliance training and assist with the on-going development/maintenance of the organization’s compliance program per OIG Requirements
  • Monitors regulatory environment; evaluates statutes, regulations, laws to determine applicability
  • Assists with the development of the Annual Compliance Work Plan based on the risk assessment and OIG Work Plan, developing or new regulatory requirements, and identified organizational deficiencies
  • Leads the work of Compliance Specialists, Compliance Assistant(s) and others


Qualifications:

  • High school diploma or GED required
  • 9 years’ experience in a healthcare regulatory environment including specific experience in project management and audit type work such as planning, supervising, executing and reviewing audits, reviews or investigations (a bachelor’s degree in healthcare or business related field can substitute for 4 years’ experience)
  • Strong in-depth knowledge of CPT, ICD-10 coding methodologies, and billing, as well an understanding of general business systems and their related control structure, knowledge of current issues affecting the healthcare industry, and in-depth knowledge of the healthcare regulatory environment
  • CPC, CCCS-P, RHIA, and/or CCS certification preferred


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