Compliance Specialist, Sr

 
Position: Compliance Specialist, Sr

Job ID: 159916

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 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching 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 the hospital’s policies/procedures and state and federal rules, regulations, and statutes. This role will also develop training modules/courses to ensure personnel are appropriately trained in their role.

 

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
  • Identifies significant issues within the scope of the audit/review/project/investigation ensuring compliance with appropriate statutes, rules, and regulations.
  • Develops on-going Compliance training and awareness initiatives required for the IDS workforce
  • Analyzes and evaluates information related to the regulatory healthcare environment by monitoring appropriate state, federal and industry web sites, publications, and journals
  • Analyzes and evaluates data, identifies risks, and makes appropriate conclusions based on audit test work, investigation, and project analysis
  • Reviews and/or edits audit/review/project/investigation issues/findings written by assistant auditors or team members to ensure accuracy, completeness, and appropriateness, determining that the identified issue/finding reveals an exposure or lapse in controls or a process and that the recommendation offers a viable, practical solution


Qualifications:

  • High school diploma or GED required
  • Bachelor’s degree preferred
  • CPC, CCS-P, RHIA, CCS or CHC certification preferred
  • 9 years’ experience in a 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 may substitute for four years of experience
  • A master’s degree may substitute for two years of experience


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