Sr Compliance and Privacy Analyst

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Identifies, researches and analyzes compliance and regulatory risk

• Researches and collects all data points relevant to the issue being investigated.
• Triages and assigns investigation to self and/or fellow team members.
• Using advanced knowledge of federal, state and local regulations, analyzes the actual and/or potential compliance risk to patients and the organization.
• Demonstrates expertise in effectively interviewing witnesses.
• Makes a determination of risk based upon discretion, judgement and regulatory analysis.
• Comprehensively documents all aspects of the investigation; communicates determination to all stakeholders and involved parties.
• Oversees corrective action plans and strategies to mitigate the compliance risk.
• Reports and communicates findings to federal agencies as appropriate.

Applies highly proficient and specialized skills to adapt and meet complex and non-routine situations.

Creates complex documents, spreadsheets and advanced graphics.

Partners with CISO and HIT Information Security team on HIPAA related matters

Responsible to perform complex coding, documentation and billing compliance reviews per the Corporate Compliance and Privacy Office Project schedule.

• Trends data for patterns of compliance and risk, reports opportunities for improvement and communicates trends to the Chief Corporate Compliance and Privacy Officer and management.
• Develops and implements projects to meet organizational and Office goals.
• Utilizes internal and external resources in an efficient and cost-effective manner.
• Serves as the primary point-of-contact for projects.
• Follows through on committed actions in a timely manner.

Identify and differentiate risks and opportunities based on the interpretation of Federal and State regulations as applied to billing compliance and privacy.

• Reviews and considers all relevant regulations, stakeholders and system implications when making decisions and offering recommendations.
• Uses multiple resources to obtain, decipher, interpret and apply regulatory guidance and effectively communicates the guidance to wide variety of audiences.
• Fosters an environment of continuous improvement, best practices and quality outcomes.
• Coordinate several ongoing projects with frequently changing priorities and deadlines.

Ensure compliance with applicable compliance and privacy laws and regulatory requirements.

• Readily maintains a comprehensive knowledge base and understanding of coding rules and guidelines to facilitate verbal and written communications with management, staff and physicians during documentation and coding auditing and monitoring projects.
• Continuously monitors project findings to ensure compliance. Prepares written reports that are comprehensive, accurate, easy to follow, and timely.
• Prepares written responses to regulatory agencies in a timely manner for review by the Chief Corporate Compliance and Privacy Officer.
• Recommends Medical Center and health system policy and procedure changes based on regulatory changes.
• Conducts and documents privacy and compliance investigations and audits per the Corporate Compliance and Privacy Office fiscal year project plan and needs.

Develop effective networks through ongoing communications with members of the management, staff, physicians, patients, families, and industry colleagues while representing the health system in a positive manner.

• Provides guidance and education to all staff on hospital billing compliance.
• Collaborates with appropriate individuals, leaders and departments when conducting compliance and privacy auditing, monitoring, and educational projects.
• Proposes innovative compliant solutions by collaboratively working with others.
• Builds relationships with people whose assistance, cooperation, and support may be needed recognizing their concerns and perspectives.
• Develops, maintains, and appropriately accesses a network of contacts within and outside of the health system.
• Serves as a resource to management, staff and physicians on medical necessity, coding guidelines, and hospital related billing laws and regulations.
• Appropriately adapts to competing demands, shifting priorities, changing regulations, and organizational constraints.

ORGANIZATIONAL DUTIES:

1. Communicates appropriately using good interpersonal skills.

Positive, professional demeanor is projected through verbal and non-verbal communications. Information for patients and staff is delivered in a manner that is supportive, timely and understandable. Interpersonal conflicts are resolved using appropriate methods and organizational resources, including but not limited to Employee Relations Services and Faculty Employee Assistance Program. Diverse perspectives are acknowledged; language and behaviors are modeled that build inclusiveness in the work environment. Ideas and suggestions are clearly communicated. Clarification of communication is requested when appropriate.

2. Serves, manages and supports internal and external customers.

Privacy is maintained at all times for patient and employee information. Actions are initiated to meet or exceed customer/co-workers expectations in delivering service by implementing the I Make the Difference philosophy (Ownership begins with me; Greet customers by making eye contact and smiling; Provide positive, professional and prompt responses, e.g. helping visitors find their way; Close every interaction with - Is there anything else I can do for you?). Appropriate resources throughout the Organization are used consistently to meet customer needs. Relationships with staff in other work areas are fostered to meet internal and external customer needs. Positive working relationships with peers, management and customers are maintained at all times. Organizational Mission and Values of Accountability, Stewardship, Professionalism, Integrity, Respect and Excellence are evident in behaviors.

3. Participates in performance improvement activities.

Participation in Performance Improvement activities and initiatives is on-going. Initiative is demonstrated to proactively diagnose and resolve problems. Change is met with positive, supportive behavior.

4. Participates as a team member and is accountable for own work responsibilities.

Time off is scheduled to avoid disrupting workflow. Help is offered to others to solve problems and complete tasks to facilitate communication and positive team dynamics. Productive work habits are consistently displayed. Accountability for actions and decisions is demonstrated in daily work. Feedback is solicited and accepted in a positive manner. Constructive input is offered to support the work unit.

MINIMUM REQUIREMENTS

Education: : Bachelor's Degree or Equivalent Education and Experience in hospital and/or academic medical center compliance and privacy related field.

Experience: 5 years of experience in a compliance and privacy related field or 3 years of experience in performing complex compliance inpatient coding reviews.
Licensure: Healthcare compliance certification through the HCCA is preferred; if not, employee should obtain this certification within 12 months of hire.
Coding certification through the AHIMA or AAPC as a CCS, CCS-P, CCA, CPC or CPC-H is required; if not, employee must obtain certification in one of the listed exams within 6 months of hire.

PHYSICAL DEMANDS
Job requires sitting for prolonged periods completing computer work and walking (distance: approximately 1 mile) throughout the day. Professional oral and written communication skills. Proficient communicative, auditory and visual skills. Attention to detail, strong interpersonal skills, and ability to write legibly. Ability to lift/push/pull 20 - 50lbs.

The University of Virginia, including the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician's Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex, pregnancy, sexual orientation, veteran or military status, and family medical or genetic information.