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Job Field: Office Jobs
Location: SALT LAKE CITY, UT
Job Type: Full Time

JOB SUMMARY:

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Compliance Officer    Requisition Number: 7376  Reg/Temp: Regular  Employment Type: Full-Time  Shift: Day  Work Schedule: Mon - Fri, 8am - 5pm Location Name: Business Services Building  City: SALT LAKE CITY  State: UT  Department: UIP CST 01H HEALTH PLANS ADMIN    Overview:    As a patient-focused organization, the University of Utah Health Care exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health Care seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our mission.    This position ensures health plan practices conform to Medicare, Medicaid, and Commercial health insurance guidelines by monitoring current practices, managing and documenting audit processes, managing and reporting appeals and grievances, developing and implementing systems to track compliance activities and providing compliance education.    The incumbent is responsible for assisting the University in preparation for regulatory audits by developing, monitoring and updating quality controls and recommending actions to maintain compliance.    This position is not responsible for providing patient care.    Responsibilities:    - Oversees, coordinates and conducts audits on documentation, abstraction and coding to ensure compliance with University, state and federal guidelines.  - Analyzes and documents audit processes. Recommends enhancements to operating policies and procedures for compliance review.  - Monitors and follows up on required documentation related to audit processes.  - Develops, monitors, and updates quality control systems to track compliance activities. Identifies trends, issues and risk areas and makes recommendations for improvement.  - Develops, coordinates and participates in educational and training programs to enhance compliance and awareness of compliance issues.  - Teams with faculty and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments.  - Maintains current knowledge regarding federal and state guidance, organizational needs, and payer regulations. Serves as an expert resource in issue resolution.    Knowledge / Skills / Abilities    - Knowledge of utilization and quality assurance procedures.  - Understanding of Health Plan operations, policies and technologies.  - Knowledge of claims auditing, Health Plan program policies and requirements (including Medicare Parts A and B), and ICD-9, CPT, HCPCS, DRG coding.  - Proficient with word processing, spreadsheet and related computer applications.  - Demonstrated human relations and effective communication skills.  - Ability to determine the validity of collected data, assessing process shortfalls, and developing effective safeguards to reduce risk.  - Ability to foster collaborative working relationships with a wide range of constituencies.    Qualifications:    Required    - Bachelorapos;s degree in Health Care Administration, Business Administration or a related field, or equivalency.  - Five years regulatory or administrative law experience, with at least three of those years in a health care setting or equivalency.  - Coding certificat

KEY REQUIREMENTS:

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