Sr. Compliance and Privacy Analyst

Using advanced knowledge required for the complex analytical functions of this job, the Senior Compliance & Privacy Analyst identifies and triages compliance issues and conducts compliance and privacy investigations using expertise of investigative procedures, research, and analysis, applies independent judgement and critical decision making to determine regulatory compliance risk to patients and the organization. The Senior Analyst uses the advanced knowledge of the regulatory compliance profession, research and auditing procedures, and certified coding regulatory and/or financial billing rules.

Uses professional verbal and written communication skills to document and communicate results and findings of compliance research, analysis and decision-making. Ensures health system compliance with applicable regulatory, accreditation and requirements. The Senior Compliance & Privacy Analyst must use independent thinking and judgement in triaging and assigning compliance and privacy investigations to fellow team members, and provide guidance to management, staff, physicians, patients, and families on billing compliance and privacy laws and regulations.

Must be self motivated and be adaptive to change.

• Identifies, researches and analyzes compliance and regulatory risk
• Researches and collects all data points relevant to the issue being investigated.
• Triages and assigns investigation to self and/or fellow team members.
• Using advanced knowledge of federal, state and local regulations, analyzes the actual and/or potential compliance risk to patients and the organization.
• Demonstrates expertise in effectively interviewing witnesses.
• Makes a determination of risk based upon discretion, judgement and regulatory analysis.
• Comprehensively documents all aspects of the investigation; communicates determination to all stakeholders and involved parties.
• Oversees corrective action plans and strategies to mitigate the compliance risk.
• Reports and communicates findings to federal agencies as appropriate
• Applies highly proficient and specialized skills to adapt and meet complex and non-routine situations.
• Creates complex documents, spreadsheets and advanced graphics.
• Partners with CISO and HIT Information Security team on HIPAA related matters

Responsible to perform complex coding, documentation and billing compliance reviews per the Corporate Compliance and Privacy Office Project schedule.

• Trends data for patterns of compliance and risk, reports opportunities for improvement and communicates trends to the Chief Corporate Compliance and Privacy Officer and management.
• Develops and implements projects to meet organizational and Office goals.
• Utilizes internal and external resources in an efficient and cost-effective manner.
• Serves as the primary point-of-contact for projects.
• Follows through on committed actions in a timely manner.

Identify and differentiate risks and opportunities based on the interpretation of Federal and State regulations as applied to billing compliance and privacy.

• Reviews and considers all relevant regulations, stakeholders and system implications when making decisions and offering recommendations.
• Uses multiple resources to obtain, decipher, interpret and apply regulatory guidance and effectively communicates the guidance to wide variety of audiences.
• Fosters an environment of continuous improvement, best practices and quality outcomes.
• Coordinate several ongoing projects with frequently changing priorities and deadlines.

Ensure compliance with applicable compliance and privacy laws and regulatory requirements.

• Readily maintains a comprehensive knowledge base and understanding of coding rules and guidelines to facilitate verbal and written communications with management, staff and physicians during documentation and coding auditing and monitoring projects.
• Continuously monitors project findings to ensure compliance. Prepares written reports that are comprehensive, accurate, easy to follow, and timely.
• Prepares written responses to regulatory agencies in a timely manner for review by the Chief Corporate Compliance and Privacy Officer.
• Recommends Medical Center and health system policy and procedure changes based on regulatory changes.
• Conducts and documents privacy and compliance investigations and audits per the Corporate Compliance and Privacy Office fiscal year project plan and needs.

Develop effective networks through ongoing communications with members of the management, staff, physicians, patients, families, and industry colleagues while representing the health system in a positive manner.

• Provides guidance and education to all staff on hospital billing compliance.
• Collaborates with appropriate individuals, leaders and departments when conducting compliance and privacy auditing, monitoring, and educational projects.
• Proposes innovative compliant solutions by collaboratively working with others.
• Builds relationships with people whose assistance, cooperation, and support may be needed recognizing…