Compliance Specialist | Compliance

Overview

Onsite position in Gainesville FL!

FTE: 1.00

Mon-Fri - 8:00 am to 5:00 pm

Position Summary:

Regulatory Compliance Specialist

The role is responsible for providing ongoing compliance monitoring and auditing for a multi-hospital healthcare system
. Key functions include the review and analysis of:

• Regulatory requirements, including but not limited to documentation and medical necessity
• Compliance with applicable laws, rules, guidelines and regulations
• Auditing, monitoring and special projects
• General compliance training and education
• Enterprise compliance policies and written standards of conduct
• General compliance processes, including inquiries, investigations and responding to reported, suspected, or confirmed non-compliance

These activities ensure both appropriate reimbursement for the hospital and adherence to all applicable laws, rules, guidelines, and regulations
.

Key Responsibilities

• Conduct ongoing compliance monitoring and auditing across UF Health.
• Perform analyses to support regulatory compliance.
• Fosters open lines of communication and communicates key compliance topics to staff and UF Health leadership.
• Deliver compliance education and training to staff.
• Research and respond to compliance-related inquiries.
• Follow established investigation protocols to address reported, suspected, or confirmed non-compliance.
• Participate in and contribute to compliance meetings
  , encouraging open communication throughout the organization.
• Assist in developing and monitoring special compliance projects in collaboration with Compliance Managers and various hospital departments.
• Provide compliance advice and guidance to staff and leadership, as needed.

• Education and Experience Options:

  • Bachelor’s degree and two (2) years of experience in compliance, clinical, coding, auditing, legal, or related fields;
    OR

  • Associate’s degree in a health or business-related field and four (4) years of experience in compliance, clinical, coding, auditing, legal, or related fields;
    OR

  • Relevant certifications in Compliance, Coding, and/or Auditing and six (6) years of experience in compliance, clinical, coding, auditing, legal, or related fields, with knowledge of healthcare laws and regulations governing hospitals and/or the healthcare industry.

• Preferred Credentials:

  • Certified in Healthcare Compliance (
    CHC
    ) credential preferred.

  • Registered Nurse (
    RN
    ), Licensed Practical Nurse (
    LPN
    ), Registered Health Information Administrator (
    RHIA
    ), Registered Health Information Technician (
    RHIT
    ), Certified Professional Coder – Hospital/Outpatient (
    CPC-H/COC
    ), Certified Professional Coder (
    CPC
    ), or Certified Coding Specialist (
    CCS
    ) preferred.

• Skills and Knowledge:

  • Familiarity with hospital billing systems and medical records.

  • Strong coding skills and a clinical background preferred.

  • Must be knowledgeable of Medicare, Medicaid, and state and federal laws and regulations governing the healthcare industry.

  • Ability to research and interpret complex regulations is required.

  • Proven problem-solving skills are essential.

  • Proficient with Microsoft Office tools, including Excel, Word, and Power Point .

  • Must be organized, versatile, and able to work independently.

• Employees in this position will operate vehicles for an assigned business purpose as a non-frequent driver
  .

• Certification in Healthcare Compliance (
  CHC
  ) can be obtained within 12 months of hire or transfer into the department.