Sparrow Health System Job - 32742048 | CareerArc
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Company: Sparrow Health System
Location: Lansing, MI
Career Level: Associate
Industries: Healthcare, Pharmaceutical, Biotech


Job Opportunity Job ID: 21400 Positions Location: Lansing, MI   Job Description General Purpose of Job:   An Description:

Positions Location: Lansing, MI


Job Description

General Purpose of Job:  

An important strategic leader within the Medicare Compliance department in the areas of prevention, detection, and correction of noncompliance, audit, policy development, risk assessment, regulatory research, and work plan projects. Responsible for regulatory interpretation, resolution of potential and actual noncompliance cases, and compliance education. The Senior Analyst will interact with internal and external compliance stakeholders and must be critical-thinking, thorough, and solutions-focused. Responsible for tracking, trending, and reporting regulatory measures and compliance reports.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis.  Associates may be asked to perform additional duties as assigned by their leader.  Leadership has the right to alter or modify the duties of the position.

  • Independently manage all aspects of compliance education, sanction screenings, incident investigation and response, and assigned audit projects. Deliver exceptional work products for these subject areas.
  • Lead the FDR oversight program to ensure all PHP departments are conducting the appropriate oversight of internal departments, and oversight and monitoring activities of the PHP Medicare first tier downstream related entities (FDRs).
  • Coordinate internal and external Medicare compliance reviews and monitor compliance efforts throughout the PHP Medicare organization.
  • Maintain and update educational materials for associates regarding compliance issues and changes in state or federal requirements related to individual job responsibilities.
  • Review and monitor content/accuracy of member information (certificates, handbooks, marketing materials, newsletters, etc.) to ensure compliance with state and federal regulations.
  • Ensure all Medicare products and services are being tested for compliance with CMS program regulations, insurance regulations, and regulatory requirements for business entities.
  • Identify, evaluate and analyze the impact of CMS and Medicare regulatory issues and advise management concerning the impact
  • Create and lead internal teams to address and resolve compliance matters in an effective and efficient manner.
  • Uphold compliant and ethical behavior in all situations and be an ambassador at all times for the Compliance Program.
  • Research, synthesize, and apply various complex state and federal healthcare regulations.
  • Create policies and procedures, compliance education, or other department communications.
  • Participation in and contribution to the risk assessment and work plan creation process.
  • Verbal communication and ability to present compliance education to various audiences.
  • Strong customer service acumen in responding to and dealing with both internal and external stakeholders.
  • Organize, track, and resolve compliance matters as they arise.
  • Oversee / perform exclusion screening of employees and vendors against OIG and GSA exclusion lists.
  • Facilitate, plan, and coordinate compliance meetings with internal and external stakeholders.
  • Participate in the SIU subcommittee of programs for detection, prevention, and investigation of provider billing errors, abuse, and fraud.
  • Act in support of PHP Medicare Privacy & Security, assisting in ongoing activities related to development, implementation, maintenance of and adherence to PHP's policies and procedures regarding the Medicare HIPAA Privacy and Security rules; and assess, implement and monitor of all aspects of HIPAA and other federal and state laws
  • Support other efforts of the PHP Medicare Compliance Department as required
Job Requirements General Requirements• Demonstrates knowledge and maintains and respects patient right to privacy by following the HIPAA Privacy and Security policies and procedures. • Adheres to ICARE values and standards of behavior (Innovation, Compassion, Accountability, Respect, Excellence). • Role model behaviors that value the diversity of our associates, patients and customers and supports creating an environment that is inclusive, welcoming and respectful. • Communicates with patients, families and customers using AIDET (Acknowledge, Introduce, Duration, Explanation, Thank). • Works in a safe manner and promptly reports any hazards identified in the work environment or related to assigned responsibilities. Work Experience• Minimum of 4 years of other forms of medical/clinical documentation, generally accepted audit principles, coding, including ICD--CM, CPT, HCPCS and medical terminology, billing claim forms including UB-92, HCFA 1500, and charging/billing procedures. • Minimum of 4 years auditing experience in varying aspects of healthcare including but not limited to hospital, outpatient surgical and physician/provider office setting. • Knowledge of Medicare/CMS regulations and/or Medicare Advantage programs requirements. • Compliance experience • Experience in Medicare compliance and insurance plan. Preferred. • Experience in Fraud and Abuse program. Preferred. Education• Bachelor's degree in health care administration, public health or business, or Bachelor's Degree in business, accounting, finance or similar field or high school diploma and six years previous experience in a health care insurance compliance, Medicare, or insurance plan capacity.Specialized Knowledge and Skills• Strong written and oral communication skills. • Interpersonal skills, leadership skills, and presentation skills. • Ability to prioritize workload and work independently. • Strong computer skills, including all Microsoft Office products. • Knowledge of Medicare/CMS regulations and Medicare Advantage programs requirements. Preferred.

Remote work will be available for this position.

Sparrow Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veteran status.

Job Family Clinical Professional/Technical/Allied Health Requirements: Shift Days Degree Type / Education Level Bachelor's Status Full-time Facility Physicians Health Plan Experience Level 4-9 Years

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