Clinical Compliance Analyst, RN

Overview: **Reports To** -------------- **Corporate Compliance Officer** This indicates the position functions within the organization's compliance structure and supports enterprise-wide compliance initiatives, audits, investigations, and regulatory monitoring. **Supervisory Responsibilities** -------------------------------- **None** The position does not directly supervise staff but serves as a subject matter expert and advisor to leadership, providers, and employees. **Coordinates With** -------------------- * All departments, management, providers, and employees throughout the organization. * Clinical and administrative staff across various locations and departments. **Required Education** ---------------------- * **Bachelor's degree in nursing (BSN).** * **Active North Carolina Registered Nurse (RN) license.** **Required Experience** ----------------------- One of the following: * **3-5 years of progressive nursing management experience**, or * **10+ years of experience in a similar clinical compliance, quality, utilization management, or regulatory role.** **Preferred Knowledge** ----------------------- * Medicare and Medicaid coverage guidelines. * Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs). * Healthcare reimbursement practices. * CPT coding and medical coding principles. **Technical Skills** -------------------- * Proficiency with **Microsoft Word, Microsoft Excel and EPIC** * Office automation and personal computer proficiency. * Email and reporting applications. **Additional Skills & Competencies** ------------------------------------ ### **Regulatory Knowledge** * Working knowledge of **HIPAA** privacy and security requirements. * Understanding healthcare compliance standards and regulatory expectations. ### **Communication & Collaboration** * Strong verbal and written communication skills are important. * Ability to work closely with multiple departments across the organization and non-FHC clinics such as PMC, PSC, CEA, etc. * Commitment to customer service and fostering positive team relationships. * Ability to educate, influence, and collaborate with clinical and administrative staff. ### **Analytical Skills** * Analytical and statistical problem-solving abilities. * Experience reviewing data, identifying trends, and evaluating compliance risks. * Ability to interpret findings and make practical recommendations. ### **Problem Solving** * Ability to identify operational or compliance issues. * Demonstrated skills in developing creative, effective solutions. * Sound judgment and critical thinking abilities. ### **Organizational Skills** * Strong attention to detail. * Ability to prioritize multiple projects and responsibilities. * Ability to meet deadlines and manage time effectively. **Policy Development & Compliance Program Support** --------------------------------------------------- * Assist in developing, updating, and maintaining compliance with policies and procedures. * Support implementation and ongoing monitoring of the organization's corporate compliance plan. * Evaluate audit processes and compliance goals and recommend improvements when needed. * Apply structured problem-solving methods to address compliance and operational issues. **Auditing, Monitoring & Investigations** ----------------------------------------- * Plan and perform financial, operational, and compliance audits. * Analyze data, evaluate findings, and communicate audit results objectively and impartially. * Monitor medical necessity, clinical documentation, coding, and billing practices. * Conduct inpatient and outpatient chart reviews. * Participate in compliance monitoring activities and internal audits. * Assist with investigations involving suspected non-compliance and support of corrective action implementation. * Maintain confidentiality throughout audit and investigative processes. **Reporting & Risk Management** ------------------------------- * Prepare reports related to audits, monitoring activities, investigations, and regulatory requirements. * Provide information that supports management of decision-making, risk reduction, and operational effectiveness. * Document audit testing, findings, recommendations, and supporting work papers thoroughly. * Maintain accurate records and compliance documentation. **Education & Training** ------------------------ * Develop educational materials related to compliance, documentation, coding, and regulatory requirements. * Provide guidance to employees, leadership, and medical staff on compliance-related matters. * Support organization-wide training regarding ethical conduct, legal requirements, and regulatory standards. * Promote a culture of compliance and accountability. **Professional Skills** ----------------------- * Strong analytical, critical thinking, and problem-solving abilities. * Ability to identify compliance risks and develop practical corrective actions. * Attention to detail and accuracy in audit documentation. * Effective verbal and written communication skills. * Sound judgment and ability to provide unbiased evaluations. * Strong organizational skills and ability to manage multiple deadlines.