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Clinical Compliance Analyst

FirstHealth of the Carolinas
Pinehurst

Job Description

Assist in development of Compliance policies & procedures for FHC. Provides assistance in the implementation and monitoring of the corporate compliance plan. Make timely evaluations of current audit procedures and goals and propose changes in them as situations warrant. Assists in the development and implementation of the compliance policies and procedures. Plans and performs financial or operational audits, examine data, evaluate information, communicate results and follow up on audits. Be able to give impartial and unbiased judgment. Assists in monitoring of medical necessity, documentation and billing processing. Perform chart reviews for inpatient and outpatient services. Assists in the investigations into reported compliance concerns, under the direction of legal counsel as appropriate. Investigates any issues of non-compliance and implements appropriate corrective regulatory procedures. Assists in compliance monitoring process including internal auditing of compliance. Assists in the preparation of reports from audits, monitoring and investigations. Assists in developing educational material related to documentation, compliance or procedures.

Bachelor's Degree in Nursing and equivalent three to five-years of progressive nursing management experience, or a minimum of ten years of experience in a similar position. Knowledge of Medicare and Medicaid coverage guidelines and reimbursement practices preferred. Prior/current acute care Case Management experience a plus. Knowledge of ICD 9 and 3M coding a plus. Proficiency in Microsoft Office Word and Excel desired. NC RN or Compact State RN License required.

Employment Type

Full Time: 36 or more hrs/wk

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