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Location: FAYETTEVILLE, North Carolina
Work Setting: Hospital
Job Function:
Job Type:



The Compliance Analyst is responsible for conducting audits to help ensure compliance with applicable statutory and regulatory requirements and organizational policies and procedures. Operational responsibilities include, but are not limited to, planning, and carrying out the annual compliance work plan and coordinating compliance activities.  Works independently and collaborate with others across the health system to review internal processes and make recommendations. Reviews and analyzes patient accounts and medical records for accuracy of documentation, medical coding, charge capture, and compliance with HIPAA, Medicare, Medicaid, TRICARE, and other applicable statutory and regulatory requirements. The position will conduct training, investigations, and audits.

Job Description


The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below; specific functions may change from time to time.


  • Schedules audit projects and develops audit plans and procedures specific to each project.
  • Researches, analyzes, and interprets rules and regulations applicable to the audit project.
  • Reviews patient accounts and medical records for accuracy of charge capture and documentation. Communicates audit findings through written reports and/or meetings with management and staff, as applicable. Provides education, as needed, and performs follow-up inquiries to assess whether recommended changes were implemented.
  • Reports all compliance, HIPAA, and risk issues to the Corporate Compliance Officer.
  • Maintains current knowledge of audit, compliance, and HIPAA issues related to the Health System.
  • Participates in Corporate Compliance Team projects and initiatives including, but not limited to, inventory test counts, New Employee Orientation, investigation of HIPAA breaches, and Find It Fix It (FIFI).
  • Assists the Corporate Compliance Officer with special projects and other job related duties as directed.






Required Qualifications




The following qualifications or equivalents are the minimum requirements necessary to perform the essential functions of this job:


Education and formal training:

  • Preferred certifications: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA)or Registered Nurse, (RN).
  • Bachelor’s Degree from an accredited college or university with a concentration in Health Information Management, Business Administration, Healthcare Administration or other related field preferred.


Work experience:

  • Minimum of five years of experience in a Health System.
  • Working knowledge of health care relevant legislation and standards for proper charge capture, documentation, and protection of health information and patient privacy.
  • Experience auditing or coding of patient medical records is required.
  • Thorough understanding of billing compliance with government programs (Medicare, Medicaid and TRICARE) to include hospital inpatient and outpatient, and Ambulance billing.
  • Ability to interpret Federal and State regulations and understand how they apply to the Health System.



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Posted: December 29, 2020 at 1:38 PM
Post ID: 56969

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