Sr. Compliance Specialist

Department

BSD OCC - Education

About the Department

The University of Chicago Medical Center is committed to promoting conduct that is responsible, ethically sound, and compliant with applicable law. The University of Chicago Medical Center (UCMC), through the Office of Corporate Compliance (OCC), fosters a corporate culture of ethical behavior and integrity in all matters related to compliance with the laws and regulations that govern the delivery and billing of health care. The OCC administers a Compliance Program that places particular emphasis on compliance with billing, coding, and documentation requirements. Additionally, the OCC actively participates in conflict of interest management initiatives and UCMC research compliance.

Job Summary

Reporting to the Director, Compliance Risk and Data Services, the Senior Compliance Specialist provides support to the programs and activities described below using strong computer and interpersonal skills; receiving and responding to internal and external inquiries and resource line calls; conducting and reporting on reviews and audits; staying abreast of current trends related to compliance regulations such as conflict of interest and billing and coding; participating in the development and delivery of training and other documents for workforce education initiatives; assisting with committee meeting preparation and maintaining compliance documentation.

Responsibilities

• Implementation: Assist departments with coding, documentation, and/or workflow advice for the compliant implementation of new non-procedural professional RVU services such as visit add-ons, specialty monthly recurring codes, and specialty stand-alone codes developed annually by CPT or CMS.

• Compliance Education:  Assist with training for the compliance education program. Training topics will include, but are not limited to FWA awareness, coding topics, and new employee orientations (BSD and Hospital). Helps to develop and/or update educational content & guidance documents.

• 1557 Coordination: Coordinate compliance for requirements related to the new Section 1557 final rule (eff Nov 2024) including Civil Rights grievance resolution coordinating with key UCM Departments as appropriate (i.e. Patient Safety, Insights, or HR, DEI).

• UCM Accountable Care Organization (ACO) Compliance: Ensure Compliance with CMS ACO requirements including creating and/or updating policies, monitoring, and reports to the UCM ACO governing body.

• Conflict of Interest:  Assist with initiatives related to UCMs financial Conflict of Interest program for employees and faculty, including Physician Compensation monitoring or audits.

• External Audit Quality & Improvement: Optimize the throughput and effectiveness of government Payor Audit Workflows, coordinating with end-user departments to improve data integrity and processes including appeals.

• Subject matter expert (SME):  Serve as subject matter expert for professional billing primarily for non-procedural services (E/Ms and add-ons), CMS teaching physician rules, documentation, and telehealth rules.

• Regulatory:  Identify and review the impact of new or revised guidance and notices released by the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, Office of Inspector General, DOJ, and other professional billing agencies.  Assist with review and summarization of proposed and final rules (including but not limited to OPPS, IPPS, PFS), communicate summaries to departments, and aid in implementation of new rules.

• Inquires & Investigation:  Assist with inquiries, investigations, and complaints received on the compliance hotline liaising with other UCM/BSD/UC partners as needed (Patient Inquiry, Privacy, HR, Clinical Departments, etc.).

• Sanction Screening:  Provide coverage as needed with the process of sanction screening Faculty and Staff against the OIG, GSA, Illinois Medicaid/OIG, and specially designated nationals lists.

• Risk:  Involvement in risk activities to ensure OCC meets its workplan goals. Participate in related process improvements to mitigate further risk.

• Compliance Projects, Policies, and Procedures:  Assist with Office of Corporate Compliance projects related to education and other initiatives in scope of this position. Update or create applicable compliance polices related to scope of position.

• Compliance Program Updates:  Present periodic updates on Compliance Education program activities at Corporate Compliance Committee, departmental meetings, etc. Utilize reports and graphs to demonstrate the progress and success of the compliance education program. 

• Guides the implementation of compliance activities designated by the Univers