Compliance Audit Nurse

SUMMARY:  

Establishes appropriate internal controls related to asset protection and insures throughout the organization: adherence to compliance plans; Medicare regulation; medical record audits; HIPAA privacy compliance

Primary Responsibilities

1. Conducts compliance audits including, but not limited to, random chart audits, in accordance with established criteria; ensures proper controls are in place and effective
2. Develops and ensures annual compliance training is conducted for physicians and staff
3. Responds appropriately to violations of Compliance Plan and brings compliance issues to attention of Executive Administrator, Managing Partner, or outside consultant as necessary
4. Works with Compliance Committee to identify organization’s compliance risks, develops compliance assessment plan at least annually, ensures compliance assessment plan is followed and that corrective action is taken when indicated
5. Reports quarterly to the Compliance Committee and Executive Committee on the operation and effectiveness of the Compliance Plan
6. Manages and oversees compliance with HIPAA regulations including the oversight of Business Associate Agreements; acts as a resource for Medicare and HIPAA regulations, and consequences of non-compliance to both
7. Develops, implements, maintains, and monitors the Compliance Program policies, the Code of Conduct, the Notice of Privacy Practices, and HIPAA Privacy and Security policies
8. Oversees and manages pay-for-performance and Meaningful Use programs including MIPS
9. Establishes appropriate internal controls
10. Adheres to and supports the Compliance Plan policies, procedures, goals, and intent.
11. Provides Committee support as needed.
12. Reports incidents in a timely manner and within 24 hours.
13. Participates in various personnel actions including but not limited compliance training for professional staff development.
14. Adheres to the Clinic’s Policy and Procedures and the Code of Conduct.
15. Maintains a flexible work schedule to accommodate any urgent compliance violation and/or complaint
16. Assists with the management of daily operations with respect to participation in Value-Based Care Programs including, but not limited to providing training and resources as necessary to physicians and staff.
17. Performs other related duties assigned and incidental to the work described herein.

Specific Areas of Responsibilities

            Intradepartmental

1. Participates in Clinic committees, provides input and ideas to improve Clinic services and operations
2. Develops a working relationship with all Physicians, Clinic personnel, and Managers to ensure overall Clinic standards are met.                          Education, Experience, and Knowledge

• • BSN Graduate of an approved school of Registered Professional Nursing (Master’s degree preferred)
    • Unrestricted license /compact license to practice in the State of Texas
• • Minimum of five (5) years of experience in healthcare compliance and/or risk management.
    • EPIC experience

• Skills and Abilities
  • Must demonstrate excellent interpersonal and organizational skills.
  • Must have excellent communication skills, including written, verbal, listening, and telephone etiquette
  • Strong attention to detail and statistical analysis skills
  • Must demonstrate excellent customer service and customer satisfaction skills.
  • Able to effectively coordinate multiple projects.
  • Must be able to demonstrate solid training skills
  • Uses analytical skills for troubleshooting and problem solving.
  • Excellent computer skills – PC, MS office including data entry in RIS scheduling.