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Department: Home Care
Shift/Schedule: Full Time (Salaried)

GENERAL SUMMARY

Works under the supervision of the Nurse Manager of Home Care Services. The Compliance Coordinator's primary job function is to facilitate the fulfillment of all regulatory and accreditation requirements for SOMC Home Care Services. Assures compliance through auditing activities, education, performance improvement, and policy recommendations. Coordinates the submission of disclosure documents, coordinating and reporting the findings of internal audits, and facilitating external audits by regulatory/accrediting agencies. Will serve as a clinical resource for all skilled staff. Performs other duties as assigned.

QUALIFICATIONS

Education:

• High School Diploma or successful completion of an equivalent High School Exam Required

• Bachelor of Science in Nursing required

Licensure:

• Licensed to practice as an RN in Ohio required

• BMVL required (Must maintain eligibility to drive as determined by SOMC insurance carriers)

• BLS within 90 days of hire required

• Certification in Healthcare Compliance preferred

Experience:

• One year of Home Health experience required

• Extensive knowledge of Home Health practices required

• Knowledge of Medicare, Medicaid, HMO and insurance coverage determinations preferred

• Proficient in medical terminology and abbreviations.

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS

The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

1. Performs audits and reviews of documentation regularly to ensure appropriate reimbursement and to reduce the chance of recoveries.

2. Ensures company processes and employees adhere to rules established to meet ethical, legal and regulatory requirements.

3. Updates policies and procedures as needed to address changes in laws, regulations and/or organization rules and obtains proper administrative review and authorization prior to implementation.

4. Stays abreast of industry standards and outlooks related to organization responsibility and compliance practices, as well as regulatory news that could affect the company’s business activities.

5. Keeps employees informed and aware of their responsibilities and the company’s obligations to maintaining ethical work practices and complying with all applicable laws and regulations.

6. Sends communications to employees when new policies/rules are established, revisions are made to existing policies and as periodic reminders of employee responsibilities to follow compliant work practices.

7. Maintains records related to reports of noncompliance and investigation requests and results.

8. Provides regular reports to Director detailing audit results, policy violations, status of investigations, status of ADR responses, corrective or preventive actions underway and any recommendations for compliance program improvements.

9. Coordinates annual compliance risk assessments and compliance reviews.

10. Works with various departments in establishing coding audits and ensures reimbursement is appropriate.

11. Leads audits and monitoring projects to address specific healthcare compliance risks.

12. Performs a variety of billing, reimbursement and compliance management activities related to agency paperwork, orders, F2F, and agency discharges.

13. Notifies clinical staff of inconsistencies in billing and documentation data, and maintains follow-up with staff to correct the inconsistencies.

14. Reports regularly to Nurse Manager any inconsistencies or non-compliance issues related to discharges, orders, F2F, or paperwork not returned timely.

15. Performs other duties as assigned.

Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status.

Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.

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