Compliance Analyst; medical coding audit & documentation

Compliance Analyst (medical coding audit & documentation)

Headquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.

Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending accounts
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

The Compliance Analyst will report to the Supervisor of Compliance & Privacy Operations and will primarily conduct research and analyze large datasets from various sources to prevent fraud, waste, and abuse. The Compliance Analyst will conduct reviews and assessments across multiple service lines to ensure adherence to state and federal regulations. This position is on the Sound Compliance team and will serve as a liaison, assisting with communication with other Central Services departments, such as Revenue Cycle Management and Legal.

This role serves as a liaison between the hospital and Sound remote colleagues to mitigate risk, including preventing inappropriate PHI disclosure, addressing other HIPAA violations, responding to regulators, and communicating with vendors. The Compliance Analyst will work with the Supervisor of Compliance & Privacy Operations to draft annual compliance education based on current state laws and federal regulations. Sound Physicians contracts with over 250 individual hospitals.

This position is both client-facing and colleague-facing.

This position ensures compliance with Federal and State laws, that Sound functions within the confines of each Business Associate Agreement (BAA), and that all contractual and regulatory obligations are met.

Essential Duties and Responsibilities

• Demonstrates the ability to communicate effectively regarding billing and documentation policies, procedures, and regulations; obtains clarification of conflicting, ambiguous, or non-specific information.
• Use relevant information and individual judgment to determine whether events or processes comply with laws, regulations, or standards.
• The ability to absorb information and form general rules or conclusions (including finding relationships among seemingly unrelated events) and apply general rules to specific problems to produce answers that make sense.
• Research and respond to compliance inquiries, draft responses to reporters, and regulators as required.
• Work closely with the Supervisor of Compliance & Privacy Operations on Risk Assessments.
• The ability to draft documents for the implementation of internal controls, compliance policies, and procedures.
• Reviewing and assessing potential fraud activity and developing fraud detection tools.
• Audits medical record documentation to identify coding variances; prepares reports of findings. Prepares reports in accordance with the Compliance Programs and develops a plan for next steps.
• Acts as a liaison and/or facilitates communication with other central service teams.
• Maintains clear and consistent communication.
• Monitors system outputs for integrity and error identification and reports all errors to management.
• Perform problem resolution, including analysis and troubleshooting.
• Project Management skills required to maintain organization and report out weekly to management on the status of current projects.
• Maintains strict confidentiality with regard to protected health information and understands and adheres to Sound’s HIPAA Privacy & Security policies and procedures.
• The ability to educate staff and management on compliance requirements and changes.

Values

• Analytical mindset: …