Sr. Compliance and Privacy Analyst

Unclassified - Farmington, NM

Full-time - Mid Level

Farmington, NM

About the position

The Senior Compliance & Privacy Analyst at SJRMC serves as a regulatory privacy and compliance specialist, responsible for managing inquiries related to compliance topics, conducting research, and assisting with the implementation and maintenance of the compliance program. This role involves performing audits, reviewing risk metrics, developing policies, conducting training, and enhancing compliance initiatives.

Responsibilities

• Assist and manage investigations for compliance and privacy concerns and/or violations through corrective actions.
• Coordinate, monitor, and audit documentation focusing on medical necessity reviews and clinical documentation to ensure compliance with regulatory guidelines and internal policies.
• Provide recommendations for educational opportunities and/or process improvement.
• Conduct new caregiver orientation and ongoing training for compliance and privacy.
• Serve as a resource for all caregivers regarding compliance and privacy guidance.
• Analyze audit results to identify patterns, trends, or variations in coding and documentation practices and make recommendations for improvement.
• Prepare quarterly compliance metric and audit reports for all findings and provide appropriate recommendations.
• Ensure corrections are communicated to the Clinic Billing Office in a timely manner and track corrections, trends, and financial impact.
• Collaborate with various departments and Compliance leadership to develop process improvement and corrective action plans based on risk assessments and audit findings.
• Perform trend analyses to identify and analyze clinical and compliance patterns in coding and documentation practices.
• Assist with policy and procedure development and revisions for Compliance and Privacy areas.
• Maintain current knowledge of federal and state regulations and guidelines, keeping abreast of changes affecting healthcare systems.
• Contribute as a voting member of the Compliance Committee and Audit and Risk Assessment Committee.
• Perform back-up coverage for system administration functions for the SJRMC contract approval and management platform and PolicyTech.

Requirements

• Associate degree
• Minimum of three (3) years' experience in healthcare compliance or auditing
• Minimum of three (3) years' experience in privacy regulations and investigations
• Experience in healthcare
• Must achieve CHC certification within twelve (12) months from date of hire

Nice-to-haves

• Bachelor's degree
• Possess one (1) of the following certifications: CHC, CHPC, CPC, CCS, or equivalent certifications
• Clinical experience working in a hospital environment
• Experience and thorough understanding of the False Claims Act