POSITION SUMMARY

The Compliance Analyst supports the Director of Reimbursement (DOR) by handling the Authority’s (RAA) compliance with medical billing, Health Insurance Portability and Accountability Act (HIPAA), Freedom of Information Act (FOIA) requests.   Serve as the subject matter expert as it pertains to the laws, regulations and rules of Medicare, Medicaid, along with other insurers as well as those Virginia laws and related areas that require agency adherence.   

POSITION DUTIES AND RESPONSIBILITIES

• Regulatory Compliance
  1. Monitor and interpret healthcare laws, regulations, and guidelines (HIPAA, Medicare/Medicaid, FOIA, etc.)

• Keeps current on rules, regulations, and industry standards for all areas of responsibility.
• Assess completeness and accuracy of CAD intake activities, crew documentation, and Billing 

• Auditing and Reporting
  1. Responsible for conducting internal audit as well as reviewing RAA’s processes with external vendors. Reporting areas of concern to appropriate members of management. 
     1. Audits Medicare, Medicaid and other payer reimbursement for accuracy.
     2. Monitors and tracks Field Operations’ compliance with required documentation, communicating areas of concern to appropriate members of management. 
     3. Evaluate internal and external factors that affect the operations of the agency. (Internal systems, payer requirements, and laws and regulations)
     4. Oversees compliance with the Commission on Accreditation of Ambulance Services (CAAS) accreditation requirements and manages the agency's re-accreditation process. 
  2. Assist in the development and implementation of compliance policies, procedures, and training programs
  3. Recommends and handles updates to RAA’s HIPAA Policies & Procedures and Compliance Code of Conduct contained in RAA’s Employee Manual.
  4. Recommend procedures and guidelines for compliance and updates them as necessary following supervisory approval.
• Liaison & Communication
  1. Collaborate with internal departments and regulatory agencies to ensure compliance standards are met. 
  2. Acts as compliance subject matter expert for Medicare, HIPAA, and records management and trains staff on requirements.   
• Data and Documentation
  1. Maintain accurate compliance records, ensuring documentation aligns with legal requirements.
  2. FOIA
     • Receive and review FOIA requests to determine if the information being requested falls within the Freedom of Information Act
     • Process FOIA requests in accordance with Virginia law.  
• Participates on committees and special projects, and performs other related duties as assigned. 
• Consistent and effective communication with all departments across the agency.

MINIMUM QUALIFICATIONS

• Bachelor's Degree in Business, Healthcare Administration, or related field or three or more years of progressively responsible experience in the compliance field (healthcare and/or public sector strongly preferred). 

PREFERRED QUALIFICATIONS

• Certification in Healthcare Compliance or ability to obtain within one year of employment.  
• Experience with public sector and/or governmental entities a strong plus.
• Working knowledge of Medicare Ambulance rules, Medicaid transportation regulations, healthcare compliance, and related business operations
• Demonstrated proactive approach and the ability to communicate effectively orally and in writing.
• Demonstrated analytical and organizational skills with a solid ability to “think outside the box.” 

PHYSICAL DEMANDS

• Must be able to sit for long periods of time.
• Must be able to lift up to 10 pounds of force occasionally, moderate lifting, carrying, pushing and/or pulling.  
• Required to have close visual acuity to perform activities such as preparing and analyzing data and figures.
• Must be able to perceive the nature of sounds at normal speaking levels with or without correction and receive detailed information through oral communication.

CONDITIONS OF EMPLOYMENT

• Candidates selected for employment are subject to a urinalysis to screen for illegal drugs.        Candidates who refuse to be tested will be denied employment with the Richmond Authority
• Candidates selected for employment are subject to a fingerprint background screening.  Candidates who refuse to be fingerprinted will be denied employment with the Richmond Authority
• New employees complete a probationary period