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The Medical Compliance Specialist 3 is part of the compliance team and promotes healthcare compliance within UHealth. The incumbent is responsible for conducting research, performing audits, monitoring and investigations, documentation reviews of the UHealth policies, rules and regulations. Additionally, he/she will contribute to the success of the compliance program by strategizing compliance risk assessment, summarizing and documenting compliance related UHealth policies and procedures, while maintain accurate records of division actions and will document communication with members of the medical community, regulatory entities and any others involved in the medical enterprise.
CORE JOB FUNCTIONS - Conducts detailed documentation reviews in support of UHealth as per the compliance review methodology.
- Assists the leader in creating the annual compliance and audit work plans.
- Analyzes audit outcomes and proactively identify trends.
- Ensures accuracy that internal, industry and Federal guidelines, as well as, State related activities are met.
- Conducts continuous training to existing or new staff regarding current and new compliance regulations.
- Creates and formalizes written internal department processes and procedures with respect to job and department functions to ensure consistency and uniformity in Compliance work product and to facilitate replication across the UHealth Compliance team.
- Generates, organizes, and presents review finding reports.
- Assists the leader to analyze review outcomes, proactively identify trends and high-risk areas.
- Maintains current knowledge, communicates changes and serves as an educational resource of national and local rules, documentation guidelines and compliance regulations.
- Manages conflict of interest disclosures and routes them for appropriate review.
- Conducts detailed research and reviews of policies and procedures in support of the UHealth compliance program.
- Identifies and reports general compliance issues that may arise through the work process; writes and revises standard operating procedures.
- Reviews technical publications, articles and abstracts to stay abreast of current regulations and trends, and makes suggestions for necessary revisions when appropriate.
- Supervises projects and other duties as assigned.
- Adheres to University and unit-level policies and procedures and safeguards University assets.
CORE QUALIFICATIONS Education: Bachelor's Degree required.
JD or RN preferred.
Experience: Minimum 5 year of relevant experience in health related, law or regulatory field or comparative experience and/or education.
Training experience, preferred.
Knowledge, Skills and Attitudes: - Must have an understanding of regulatory compliance and be familiar with federal and state healthcare regulatory agencies.
- Knowledge of documentation guidelines in an academic medical center preferred.
- Excellent communication (written and verbal) skills.
- Detailed oriented person with strong organizational, analytical, interpersonal and motivational skills required.
- Ability to work as a team player and to collaborate well with others.
- Strong computer skills utilizing Microsoft Office suite (i.e., Word, Excel, Access, PowerPoint), other web-based applications.
- Proven ability to handle sensitive and confidential information appropriately.
Department Specific Functions - Conduct detailed research and reviews of policies and procedures in support of the UHealth Regulatory Compliance program, which are assigned and prioritized by the Executive Director of Regulatory Compliance.
- Assists and supports the work of the Executive Director and Director in regulatory arena.
- Conduct investigations as needed.
- Maintain strict confidentiality of all matters.
- Assists the Department in training and education in compliance topics.
- Identifies and reports general compliance issues that may arise through the work process; writes and revises standard operating procedures.
- Reviews technical publications, articles and abstracts to stay abreast of current regulations and trends, and makes suggestions for necessary revisions when appropriate.
- Generates and organizes audit finding reports.
- Continuous training of current Compliance Specialists (1) and new hired Compliance Specialists (1).
- Analyzes audit outcomes and proactively identify trends.
- Provides timely and concise audit feedback to the Director.
- Maintains current knowledge of changes in national and local Healthcare Rules and Regulations.
- Represents the UHealth University of Miami Miller School of Medicine in an ethical and professional manner
- Maintains current knowledge, communicates changes and serves as an educational resource of various areas of regulatory concerns, including but not limited to, physician contracting, emergency medical treatment & labor act (EMTALA), Stark law, anti-kickback statute, civil monetary penalties, false claims act, and any other regulatory issues that arise.
- Collaborate with Director in creating the annual Regulatory Audit Work Plan.
- Assists in analyzing review outcomes, proactively identify trends and high-risk areas.
- Prepares and presents the final review results to the Manager and/or Director.
- Promotes compliance, best practices and solutions.
- Special projects and other duties as assigned
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The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.
UHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We're the challenge you've been looking for.
Patient safety is a top priority. As a result, during the Influenza ("the flu") season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.
The University of Miami is an Equal Opportunity Employer - Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.
Job Status: Full time
Employee Type: Staff
Pay Grade: c106