Description
Department BSD OCC - Education About the Department The University of Chicago Medical Center is committed to promoting conduct that is responsible, ethically sound, and compliant with applicable law. The University of Chicago Medical Center (UCMC), through the Office of Corporate Compliance (OCC), fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and billing of health care. The OCC administers a Compliance Program that places particular emphasis on compliance with billing, coding, and documentation requirements. Additionally, the OCC actively participates in conflict of interest management initiatives and UCMC research compliance. Job Summary Reporting to the Director, Compliance Risk and Data Services, the Senior Compliance Specialist provides support to the programs and activities described below using strong computer and interpersonal skills; receiving and responding to internal and external inquiries and resource line calls; conducting and reporting on reviews and audits; staying abreast of current trends related to compliance regulations such as conflict of interest and billing and coding; participating in the development and delivery of training and other documents for workforce education initiatives; assisting with committee meeting preparation and maintaining compliance documentation. Responsibilities Implementation: Assist departments with coding, documentation, and/or workflow advice for the compliant implementation of new non-procedural professional RVU services such as visit add-ons, specialty monthly recurring codes, and specialty stand-alone codes developed annually by CPT or CMS. Compliance Education: Assist with training for the compliance education program. Training topics will include, but are not limited to FWA awareness, coding topics, and new employee orientations (BSD and Hospital). Helps to develop and/or update educational content & guidance documents. 1557 Coordination: Coordinate compliance for requirements related to the new Section 1557 final rule (eff Nov 2024) including Civil Rights grievance resolution coordinating with key UCM Departments as appropriate (i.e. Patient Safety, Insights, or HR, DEI). UCM Accountable Care Organization (ACO) Compliance: Ensure Compliance with CMS ACO requirements including creating and/or updating policies, monitoring, and reports to the UCM ACO governing body. Conflict of Interest: Assist with initiatives related to UCMs financial Conflict of Interest program for employees and faculty, including Physician Compensation monitoring or audits. External Audit Quality & Improvement: Optimize the throughput and effectiveness of government Payor Audit Workflows, coordinating with end-user departments to improve data integrity and processes including appeals. Subject matter expert (SME): Serve as subject matter expert for professional billing primarily for non-procedural services (E/Ms and add-ons), CMS teaching physician rules, documentation, and telehealth rules. Regulatory: Identify and review the impact of new or revised guidance and notices released by the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, Office of Inspector General, DOJ, and other professional billing agencies. Assist with review and summarization of proposed and final rules (including but not limited to OPPS, IPPS, PFS), communicate summaries to departments, and aid in implementation of new rules. Inquires & Investigation: Assist with inquiries, investigations, and complaints received on the compliance hotline liaising with other UCM/BSD/UC partners as needed (Patient Inquiry, Privacy, HR, Clinical Departments, etc.). Sanction Screening: Provide coverage as needed with the process of sanction screening Faculty and Staff against the OIG, GSA, Illinois Medicaid/OIG, and specially designated nationals lists. Risk: Involvement in risk activities to ensure OCC meets its workplan goals. Participate in related process improvements to mitigate further risk. Compliance Projects, Policies, and Procedures: Assist with Office of Corporate Compliance projects related to education and other initiatives in scope of this position. Update or create applicable compliance polices related to scope of position. Compliance Program Updates: Present periodic updates on Compliance Education program activities at Corporate Compliance Committee, departmental meetings, etc. Utilize reports and graphs to demonstrate the progress and success of the compliance education program. Guides the implementation of compliance activities designated by the University's strategic plans. Monitors University compliance with regulations and laws. Has a deep understanding to develop and administer policies related to affirmative action, non-discriminatory practices for persons with disabilities, and unlawful harassment or sexual misconduct. May provide confidential counseling and expertise to those who feel they have experienced unlawful treatment based on University programs and activities. Represents the University in regulatory proceedings before federal, state and local agencies. Prepares the University's position statements and responses to information requests. Performs other related work as needed. Minimum Qualifications Education: Minimum requirements include a college or university degree in related field. Work Experience: Minimum requirements include knowledge and skills developed through 5-7 years of work experience in a related job discipline. Certifications: --- Preferred Qualifications Education: Bachelor's degree in business administration, health policy or health information administration, or law degree. Master’s degree in business administration, health policy or health information administration, or law degree. Experience: Experience in compliance, conflict of interest, and health information administration. Previous experience in a hospital, physician office, or compliance setting. Experience at a hospital, academic medical center, or other large, complex corporate organization. Licenses and Certifications: Medical coding certification. If not coding certified demonstrates understanding and ability to apply coding principles. Preferred Competencies Demonstrated knowledge and understanding of compliance concepts, such as Fraud Waste and Abuse, Conflicts of Interest, CMS Teaching Physician Rules, revenue cycle, coding, and documentation requirements. Demonstrated analytical skills sufficient to produce reports and graphs related to assessment result and the progress and success of the compliance program. Excellent written and verbal skills and ability to communicate rules and information to staff at all levels confidently. Demonstrates capacity to work independently in an organized, detailed manner while maintaining a collaborative team environment. Established skill in managing multiple projects while responding to shifting priorities and meeting changing deadlines in a positive manner. Communicate effectively in written and oral form and follow written and/or verbal instructions. Ability to comprehend technical documents. Ability to condense complicated issues to simple summaries that can be understood by a variety of constituents. Exercise absolute discretion regarding confidential matters and handle sensitive matters with tact and discretion. Ability to multitask, work under pressure, and prioritize work to meet deadlines while working independently and exercising attention to detail. React effectively, quickly, calmly, and rationally during conflicts and emergencies. Work effectively and collegially with little supervision or as member of a team with members from diverse cultures and backgrounds. Display active listening, critical thinking, decision making ability, problem solving, and quantitative, analytical and time management skills. Working Conditions Hybrid, Primarily Remote Work from Home (minimal travel to Hyde Park campus when needed). Office environment. Application Documents Resume (required) Cover Letter (preferred) When applying, the document(s) MUST be uploaded via the My Experience page, in the section titled Application Documents of the application. Job Family Legal & Regulatory Affairs Role Impact Individual Contributor Scheduled Weekly Hours 40 Drug Test Required No Health Screen Required No Motor Vehicle Record Inquiry Required No Pay Rate Type Salary FLSA Status Exempt Pay Range $80,000.00 - $110,000.00 The included pay rate or range represents the University’s good faith estimate of the possible compensation offer for this role at the time of posting. Benefits Eligible Yes The University of Chicago offers a wide range of benefits programs and resources for eligible employees, including health, retirement, and paid time off. Information about the benefit offerings can be found in the Benefits Guidebook. Posting Statement The University of Chicago is an Affirmative Action/Equal Opportunity/Disabled/Veterans and does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender, gender identity, national or ethnic origin, age, status as an individual with a disability, military or veteran status, genetic information, or other protected classes under the law. For additional information please see the University's Notice of Nondiscrimination. Staff Job seekers in need of a reasonable accommodation to complete the application process should call 773-702-5800 or submit a request via Applicant Inquiry Form. We seek a diverse pool of applicants who wish to join an academic community that places the highest value on rigorous inquiry and encourages a diversity of perspectives, experiences, groups of individuals, and ideas to inform and stimulate intellectual challenge, engagement, and exchange. All offers of employment are contingent upon a background check that includes a review of conviction history. A conviction does not automatically preclude University employment. Rather, the University considers conviction information on a case-by-case basis and assesses the nature of the offense, the circumstances surrounding it, the proximity in time of the conviction, and its relevance to the position. The University of Chicago's Annual Security & Fire Safety Report (Report) provides information about University offices and programs that provide safety support, crime and fire statistics, emergency response and communications plans, and other policies and information. The Report can be accessed online at: http://securityreport.uchicago.edu. Paper copies of the Report are available, upon request, from the University of Chicago Police Department, 850 E. 61st Street, Chicago, IL 60637. The University of Chicago is an urban research university that has driven new ways of thinking since 1890. Our commitment to free and open inquiry draws inspired scholars to our global campuses, where ideas are born that challenge and change the world. We empower individuals to challenge conventional thinking in pursuit of original ideas. Students in the College develop critical, analytic, and writing skills in our rigorous, interdisciplinary core curriculum. Through graduate programs, students test their ideas with UChicago scholars, and become the next generation of leaders in academia, industry, nonprofits, and government. To learn more about the university click here http://www.uchicago.edu/
