Title: Healthcare Compliance Specialist - Practice Plan

Department Org: Internal Audit - 104920

Employee Classification: U1 - Unclassified PSA FT

Bargaining Unit: Professional Staff Association

Primary Location: MC AD

Shift: 1

Start Time: 8:30am End Time: 5pm

Posted Salary: $57,246- $71,526

Float: No

Rotate: No

On Call: No

Travel: No

Weekend/Holiday: No

Job Description:

The Healthcare Compliance Specialist – Practice Plan is responsible for assisting with overseeing and guiding the Compliance Program for the Physicians Practice Plan (UTP). Duties include ensuring ethical and compliant practices are implemented and maintained across the organization in accordance with all applicable federal and state laws, regulations, ordinances, commercial payers’ rules and regulations internal policies and procedures, and other requirements as they relate to operations, billing, coding, proper payment, documentation practices, and the delivery of quality care in a compliant manner. This person oversees doing investigations in the field, working with general counsel, managing hotline calls, and managing risk as it related to compliance issues.

Minimum Qualifications:

Education/experience/licensing:
• Must have a minimum of three (3) to five (5) years of experience in healthcare operations.
• Bachelor’s degree preferred with emphasis on nursing – not required
• Working knowledge of medical terminology, CPT, and ICD-10
• A minimum of three (3) to five (5) years of experience as a certified physician coder preferred
• RHIT, RHIA, or Certified Degree in Coding preferred

Communication and other skills:
• Must have demonstrated leadership skills, strong written and verbal communication skills, and ability to work independently.
• Must have ability to escalate confidential and sensitive matters involving privacy and compliance.
• Current knowledge of healthcare – federal and state privacy regulations and third-party regulations regarding medical record documentation
• Must have ability to monitor advancements in information technology to ensure organizations adoption and compliance.
• Strong positive verbal and written communication skills.

Conditions of Employment:

Equal Employment Opportunity Statement:

The University of Toledo is an equal opportunity, affirmative action employer. The University of Toledo does not discriminate in employment, educational programs, or activities on the basis of race, color, religion, sex, age, ancestry, national origin, sexual orientation, gender identity and expression, military or veteran status, disability, familial status, or political affiliation.

The University is dedicated to the goal of building a culturally diverse and pluralistic faculty and staff committed to teaching and working in a multicultural environment and strongly encourages applications from women, minorities, individuals with disabilities, dual-career professionals and covered veterans.

The University of Toledo provides reasonable accommodation to individuals with disabilities. If you require accommodation to complete this application, or for testing or interviewing, please contact the Human Resources Department at 419-530-4747 between the hours of 8:30AM and 5:00PM or apply online for an accommodation request.

Computer access is available at most public libraries and at the Office of Human Resources located in the Center for Administrative Support on the Main Campus of the University of Toledo.