Compliance Specialist - USFHP

The Compliance and Appeals Specialist position manages the USFHP Compliance and Integrity Program under the direction of the USFHP Senior Claims Manager.  This position is responsible for the daily operations of the USFHP Compliance and Integrity Program, including but not limited to:

• Define and execute an annual Integrity Program covering a minimum of 10 Integrity Audits and Recouperation activities and reporting
• Review and Update all Compliance related policies and procedures annually, working cross functionally, with USHFP leadership, and Providence Compliance
• Review, analyze, and take appropriate action for all T5, Tricare, or TOM updates, changes, or modifications
• Execute quarterly on-site compliance reviews
• Prepare all of the required documentation and updates for Quarterly Compliance Committee meetings
• Stay up to date on all required coding knowledge and certification
• Assist the Claims team and Claims Quality roles with CMS interpretation, coding, and claims queries/appeals investigations

The successful candidate in this role will be a proactive, effective communicator who is passionate about compliance and who is skilled at working cross functionally, and across the wider Providence community to ensure best practice and adherence to standards at USFHP at all times.  Must be proficient/advance in Excel skills -comfortable using large amounts of data, pivot table, creating reports, and communicating results to leaders across the business. 

Pacific Medical Centers (PacMed) is a private, not-for-profit, primary and integrated multi-specialty health care network with 9 outpatient clinics and more than 175 primary and specialty care providers in King, Snohomish and Pierce counties. Our patient and staff populations are culturally diverse, creating a stimulating and rewarding workplace. Our strong team environment and respect for our people—at all levels and from all backgrounds—allow us to provide authentic care that achieves the highest-quality patient outcomes, backed by the strong network of resources and support through our affiliation with the Providence family, including local partners like Swedish Medical Group. 

Required qualifications:

• 2 years Compliance/privacy experience in a healthcare setting.
• 2 years AAPC or AHIMA Coding Credential (CPC, CPCO, CPMA, CCS, etc)

Preferred qualifications:

• Bachelor's Degree in Healthcare Business or health-related field.
• Coursework/Training: Healthcare compliance certification, (CHC).
• 3 years Information Security, Health Information Management, Accreditation Services, or Revenue Cycle Services in lieu of direct Compliance/Privacy experience.

 

Why Join Providence? 

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security.  We take care of you, so you can focus on delivering our mission to advocate, educate and provide extraordinary care.

 

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits.