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Sound Physicians · 14 hours ago

Compliance Analyst

United States

Full-time

Remote

Entry Level

1+ years exp

Sound Physicians is a healthcare organization that contracts with over 250 hospitals. They are seeking a Compliance Analyst to conduct research and analyze datasets to prevent fraud and ensure adherence to regulations, while serving as a liaison between various departments and stakeholders.

Emergency MedicineHealth CareHospitalMedical

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

Qualification

Coding CertificationCompliance Management SoftwareAuditing ConceptsRisk AssessmentMedical Coding KnowledgeAnalytical SkillsProject ManagementInterpersonal SkillsCommunication SkillsProblem SolvingOrganizational Skills

Required

High school Diploma or GED certificate

Coding Certification required (Any of CPC, CPC-H, CCS, CCS-P)

Experience using compliance management software, such as GRC, or data security is a plus

At least one year of experience coding Evaluation and Management services

Ability to clearly communicate medical coding information

Knowledge of auditing concepts and principles

Skills in research, auditing, risk assessment, and communication

Knowledge and understanding of professional fee coding (CPT and ICD-10), physician group practice revenue cycle processes, regulatory compliance issues related to billing and coding, documentation standards, and third-party payer processes

Experience in related roles like auditing, risk management, or operations provides a strong foundation, with specific industry knowledge (e.g., HIPAA in healthcare, AML in finance)

Strong written and verbal communication and interpersonal skills

Ability to use independent judgment and to manage and impart confidential information

Ability to adapt, modify, and prioritize audit functions as required

Excellent analytical and critical-thinking skills

Excellent organizational skills

Excellent written and oral communication skills

Strong interpersonal skills

Creative and persistent problem solver

Client service-oriented (both internal and external)

Ability to multitask and prioritize workload in a fast-paced environment