Employment Type:

Full time

Shift:

Day Shift

Description:

This role is within the Integrity and Compliance department of IAS in the professional services Center of Excellence, providing support for the seven elements of an effective compliance program. This role is primarily responsible for the functions of coding, auditing, monitoring, and education delivery efforts for professional services which relies on a thorough understanding of the Medicare Physician Fee Schedule, Medicare Claims Processing Manual, National Correct Coding Initiatives, current procedural terminology, and International Classification of Diseases coding guidelines.

Position Purpose: Applies credentialed subject matter expertise in field of professional coding, documentation, claims submission and reimbursement policies as required by state and federal payers to conduct auditing and monitoring of health ministries. Responsibilities include assisting in the completing scheduled work plan reviews, as well as assist in conducting research, investigations, and defense activities in response to inquiries from Ministries, Medicare, Office of Inspector General, Department of Justice or other programs. Assists in interpreting, disseminating, and educating Trinity Health Ministries with federal policy changes, and other pertinent regulatory updates as they occur.

Purpose

Responsible for the data capture, analysis & reporting of data information to assist the Trinity Health leadership team achieve operational efficiency. Responsible for auditing of department information, producing reports, & suggesting improvements to processes. Provides knowledge & expertise in the program, services & applications.

Essential Functions

Our Trinity Health Culture: Knows, understands, incorporates & demonstrates our Trinity Health Mission, Values, Vision, Actions & Promise in behaviors, practices & decisions.

Work Focus: Researches, collects & analyzes information. Identifies opportunities, develops solutions, & leads through resolution. Collaborates on performance improvement activities as indicated by outcomes in program efficiency & patient experience. Responsible for distribution of analytical reports.

Process Focus: Utilizes multiple system applications to perform analysis, create reports & develop educational materials. Incorporates basic knowledge of TH policies, practices & processes to ensure quality, confidentiality, & safety are prioritized. Demonstrates knowledge of departmental processes & procedures & ability to readily acquire new knowledge.

Data Management & Analysis: Research & compiles information to support ad-hoc operational projects & initiatives. Synthesizes & analyzes data & provides detailed summaries including graphical data presentations illustrating trends & recommending practical options or solutions while considering the impact on business strategy & supporting leadership decision making. Leverages program & operational data & measurements to define & demonstrate progress, ROI & impacts.

Maintains a working knowledge of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of Conduct, as well as other policies, procedures & guidelines in order to ensure adherence in a manner that reflects safe, honest, ethical & professional behavior & safe work practices.

Minimum Qualifications

Bachelor’s degree or an equivalent combination of education and experience. Experience working in a health care organization or equivalent work experience demonstrating knowledge and understanding of the laws and regulations impacting the health care provider industry, specifically health care corporate compliance programs.

Certification in Healthcare Compliance (“CHC”) designation or willingness to obtain certification within two (2) years of hire.

Additional Qualifications (nice to have)

Possess and maintain licensure or certification in compliance, law, audit, privacy, healthcare, or other relevant field or area of study. Experience with government audits, inquiries, investigations, response, and mitigation.

Master's or professional degree in law, business or health care preferred.

Hourly pay ranges: $27.41 - $46.88

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

Trinity Health

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(Hybrid / Remote) Integrity & Compliance Specialist