Compliance Associate, II

Job Description

Job Description

Company Description

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits : from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Job Description

The Compliance Associate II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

Responsibilities :

• Help manage all aspects of the Compliance Hotline and compliance issues received via e-mail and phone.
• Help ensure reported issues are appropriately received, evaluated, investigated, documented, and resolved.
• This position has primary responsibility for auditing / reviewing provider
• documentation, coding, and billing to ensure that the documentation supports the CPT codes billed to government payors.
• Results of the provider audits / reviews are shared with the provider, so strong written and verbal communication skills are important.
• Strong coding understanding, professional coding certification is required.
• Responsible for answering inquiries related to professional documentation, coding, and billing regulatory requirements.  Work with Senior / Manager / Director on more complex issues or investigations.
• Respond to queries or allegations and triage issues to appropriate departments when necessary (i.e., Human Resources Compliance).
• Assist with maintaining a log / database of all issues received by the department through the compliance hotline, e-mails, phone calls, etc.
• Document all issues received, actions taken, and resolutions.
• Maintain a current understanding of regulatory trends and changes in compliance and regulatory guidelines that affect NMHC and its subsidiaries by monitoring various resources to assess regulatory changes and determine organizational impact.
• Coordinate investigations in response to incoming compliance related issues.
• Gather all relevant information for potential compliance issues, determine underlying causes, and relate information from different sources to draw logical conclusions.
• Coordinate non-coding and non-billing related audits, reviews and, when necessary, investigations (in conjunction with the Corporate Compliance Manager) in response to CMS, OIG, and / or other regulatory concerns that emerge throughout the year.
• Perform follow-up, audits, reviews, investigations, and validations.
• Assist with data analysis to determine root cause of reported or identified issues and determine level of escalation required.
• Assist with the development of compliance education and training materials.
• Assist departments in the development of corrective action plans for identified issues.
• Assist with the development of dashboards, written reports, or other deliverables to be presented to the department, VP Integrity, Senior Leadership, and / or the Audit Committee.
• Support and assist the Corporate Compliance Manager in identifying and assessing areas of compliance risk for NMHC
• Assist with the development and implementation of the departments annual Compliance Work Plan.
• Help develop and maintain compliance-related policies and procedures to ensure they are current and relevant.
• Assist with providing policy-related guidance to individuals and departments.
• Perform other duties assigned by the department Managers, Director, or VP, Integrity.

AA / EOE.

Qualifications

Required :

Preferred :

Additional Information

Northwestern Medicine is an affirmative action / equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.