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Home Health/Hospice Compliance Specialist

Company: Frontpoint Health
Location: Dallas
Posted on: November 26, 2022

Job Description:

*Job Description: *

Responsible for ensuring that the home health and hospice agencies follow the rules and regulations set forth by government agencies. Responsible for helping create, implement, and maintain a compliance program. You will work with a variety of departments such as Human Resources, marketing, sales, and accounting to ensure overall compliance.

*Responsibilities: *

* Performs targeted audits to monitor adherence to healthcare federal and state regulations (e.g., OIG risk areas, PEPPER reports)
* Develop response letters to support home health/hospice eligibility for Additional Documentation Requested (ADR's), Unified Program Integrity Contractor (UPIC's), Zone Program Integrity Contractor (ZPIC's), Targeted Probe and Educate audits (TPEs) and Comprehensive Error Rate Testing (CERT's).
* Develop requests for appeals, when applicable and monitor the appeal process
* Work collaboratively with Clinical Services team to develop education and training
* Assist in aspects of orientation and in-services program
* Help manage the process for all government payment audits
* Ensure that employees are following the proper procedure when it comes to patient data, billing, insurance claims, etc.
* Educate Executive Directors, leadership team and employees on ways to recognize, prevent, report, and resolve instances of conflict of interest, medical record documentation errors involving fraud, waste, and abuse, HIPAA privacy violations, and other compliance concerns in the home healthcare environment.
* Organize, document, track and resolve compliance issues as they arise.
* Investigate and manage complaints relating to home health/hospice service related and patient care concerns
* coordinate appropriate members of the investigative team and facilitate calls with field investigators to review findings and develop investigation plans.
* Other duties as assigned

*Knowledge/Skills: *

* Knowledge and ability to adhere to Government (Department of Health and Homeland Security) and Contract regulations, including Fedcap policies and procedures.
* Ability to maintain confidentiality in compliance with the Health Insurance Portability and accountability Act (HIPPA).
* Ability to resolve problems within scope of responsibilities, utilizing good judgment as required.
* Ability to communicate and interact effectively professionally with all levels of staff, working collaboratively as part of the team.
* Verbal and written communication skills to explain complex regulations and procedures to others
* Excellent attention to detail to ensure they follow all regulations (includes keeping track of all the regulations and laws that affect the healthcare industry and the company or organization they work for)
* Strong organizational skills for tasks such as reviewing patient records, reviewing healthcare policies and procedures, and ensuring that everything is in compliance with federal regulations
* Ability to work under pressure
* Problem-solving

*Requirements: *

* Bachelor's degree in health administration, health information management, or a related field.
* 2-3 years' of experience with healthcare compliance and ethics programs, including knowledge of the elements of an effective compliance program. Familiarity with the laws, rules and regulations impacting health care

Job Type: Full-time

Pay: $65,000.00 - $80,000.00 per year

* Dental insurance
* Health insurance
* Vision insurance
* 8 hour shift
* Monday to Friday

Ability to commute/relocate:
* Dallas, TX 75234: Reliably commute or willing to relocate with an employer-provided relocation package (Required)

* Compliance management: 2 years (Preferred)

Work Location: One location%58047475%

Keywords: Frontpoint Health, Dallas , Home Health/Hospice Compliance Specialist, Healthcare , Dallas, Texas

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