Job Details

Regulatory Compliance Administrator
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Position Number: 5095530
Location: Salt Lake City, UT
Position Type: Health and Medical Services

Regulatory Compliance Administrator

Job Summary

The Regulatory Compliance Administrator collaborates with providers, managers, and staff to assist departments, clinics, and/or service lines in implementing, coordinating, and monitoring compliance practices.
This incumbent is responsible for conducting medical necessity audits by reviewing clinical practice standards and documentation. The incumbent will conduct and respond to audits and projects related to regulatory and payment integrity to ensure accurate and timely responses to governmental contractors. In addition to the clinical expertise needed for the medical necessity reviews, the incumbent will perform scheduled and unscheduled regulatory and payment integrity audits, develop and standardize policies and procedures, training and education, compliance investigations, and reporting to ensure compliance with University, State, and Federal guidelines.
The incumbent must be highly skilled in time management and possess strong communication skills. The incumbent will work with their team to evaluate and review individual skills and knowledge level and assign tasks accordingly. Must be able to provide mentoring to supporting roles within the team.
This position is not responsible for providing patient care. This position has the possibility of remote work.

Responsibilities
Essential Functions

Maintains current knowledge regarding federal and state guidance, organizational needs, and regulations.
This position prioritizes governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel.
Reviews documentation for medical necessity and utilizes industry standard tools such as InterQual or Milliman.
Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.
Assists the University in preparing and completing regulatory audits by developing, monitoring, and updating quality controls and recommending actions to maintain compliance.
Oversees, coordinates, and conducts audits/investigations to ensure compliance with University, State, and Federal guidelines.
Analyzes and documents compliance processes. Recommends enhancements to policies and procedures for compliance review.
Designs and implements training and education programs to enhance compliance awareness.
Serves as an expert resource in compliance issue resolution.

This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job

Work Environment and Level of Frequency typically requiredNearly Continuously: Office environment.Physical Requirements and Level of Frequency that may be requiredNearly Continuously: Sitting, hearing, listening, talking.Often: Repetitive hand motion (such as typing), walking.Seldom: Bending, reaching overhead.

Minimum Qualifications

Three to five years of clinical experience in a patient care capacity is required.
Patient care experience may be substituted with equivalent years of experience in medical necessity review.
Current medical licensure through DOPL (or equivalent state agency) such as, but not limited to: RN, BSN, NP, PA, etc preferred.
Must be proficient with word processing, spreadsheet, and related computer applications and have exemplary human relations and effective communication skills.
Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities.
Department may require coding certification (CPC, ACS, CCS-P/H, RHIA, or RHIT).

Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.

Preferences

Knowledge of utilization review and quality assurance procedures, as well as experience with InterQual or Milliman and Case Management procedures of medical necessity auditing
Bachelors Degree in Health Care Administration, Business Administration, or a related field, or the equivalent
Knowledge of medical auditing, Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD-10, CPT, HCPCS, DRG coding
Coding certification (CPC, CPC-H, ACS, CCS-P/H, RHIA)
- If not current, must be willing to obtain within the first six months of employment
Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA)
- If not current, must be willing to obtain within the first six months of employment

Special Instructions

Requisition Number: PRN37888B
Full Time or Part Time? Full Time
Work Schedule Summary: This position has the possibility of remote work
Department: 01663 - COMPLIANCE SERVICES
Location: Campus
Pay Rate Range: $60,700 -$95,000 DOE
Close Date:
Open Until Filled: Yes

To apply, visit https://utah.peopleadmin.com/postings/161428