Senior Compliance Auditing Specialist

Under the general supervision of the Vice President of Compliance, the Senior Compliance Auditing Specialist serves in a managerial role to ensure that the Board, management, and employees of DWIHN are following the rules and regulations of regulatory agencies, that DWIHN policies and procedures are being followed, and that behavior in the organization meets the Network’s Standards of Conduct.

 PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Supervises various aspects of the compliance program.
• Ensures proper adherence to policies and procedures.
• Responds to and manages individual compliance cases ensuring departmental compliance with all applicable laws and regulations during departmental actions. 
• Manages and coordinates Compliance Investigations. 
• Trains employees in proper case documentation. 
• Partners with colleagues to assist in the development and maintenance of new procedures and operational changes that minimize risk, add value, and anticipate trends in areas of responsibility.
• Maintains meticulous records, including policies, procedures, and compliance documentation, to satisfy client and regulatory agency requirements.
• Completes Office of Inspector General (OIG) Reports.
• Conducts Compliance Staff Training for DWIHN employees.
• Reviews the DWIHN employee and provider credentialing process for compliance with regulatory standards.
• Consults with legal counsel as needed to resolve difficult legal compliance issues.
• Identifies potential areas of compliance vulnerability and risk.
• Develops and implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or resolve similar situations in the future.
• Provides compliance and other related reports. 
• Researches and analyzes available sources of regulatory guidance in response to specific questions.
• Monitors available sources of regulatory guidance to proactively address the necessary changes to the HIPAA compliance implementation plan based on documentation and feedback.
• Maintains a strong working knowledge of applicable regulatory guidelines. 
• Coordinates with the appropriate administrative and support departments to adequately design implementation plans, policies and analyzes the effects of any proposed process changes required by HIPAA.
• Coordinates the systematic reviews of the various departments' HIPAA compliance status.
• Performs related duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S):

• Knowledge of requirements under Corporate Integrity Agreements (CIAs) and Certificate of Compliance Agreements (CCAs), HIPAA, and the Emergency Medical Treatment and Labor Act (EMTALA).
• Knowledge of health care fraud and abuse laws, including the False Claims Act, Stark Laws, Sarbanes-Oxley internal controls testing, and the Anti-Kickback Statute, including the associated penalties.
• Knowledge of health care law, regulations and standards.
• Knowledge of coding and reimbursement systems, risk management and performance improvement.
• Knowledge of governmental compliance regulations.
• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the DWIHN provider network and community resources.

• Knowledge of the Michigan Mental Health Code.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
• Knowledge of NCQA requirements and the accreditation process.
• Knowledge of the principles and methodology of total quality management (TQM)/ continuous quality improvement (CQI), specifically the PDSA/PDCA Cycle, quality tools and techniques, and models for improvement.
• Knowledge of contracting policies and procedures.
• Knowledge of HIPPA Compliance.
• Knowledge of Certified Community Behavioral Health Clinics (CCBHC) rules and regulations.
• Knowledge of SAMSA regulations.

• Knowledge of Community Mental Health Service Providers (CMHSPs) rules and regulations.
• Knowledge of Office of Inspector General (OIG) rules and regulations.
• Supervisory skills.
• Rational decision-making skills.
• Corrective Action skills.
• Assessment skills.
• Organizational skills.
• Planning skills.
• Accuracy skills.
• Analytical skills.
• Time Management skills.
• Report writing skills.
• Logical skills.
• Reasoning skills.
• Problem Solving skills
• Decision Making skills.
• Presentation skills.
• Interpersonal skills.
• Multitasking skills.
• Prioritizing skills.
• Computer skills
• Teamwork Skills
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work effectively with others.
• Ability to act ethically and with confidentiality.
• Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
• Judgement/Reasoning ability.

REQUIRED EDUCATION:

A Bachelor’s degree in Business Administration, Healthcare Administration, Public Administration or a related field or a Juris Doctorate.  

REQUIRED EXPERIENCE:

 Five (5) years of professional experience working in compliance, healthcare, or law with a proven track record in healthcare regulatory matters.

 REQUIRED LICENSE(S).

A valid State of Michigan Driver’s License with a safe and acceptable driving record.

Certification in one of the following, preferred: CHC, CHPC, CHRC, CHC-F.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.  This position can work remotely with supervisory approval.  Currently this position is a hybrid position.

This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed.  Management retains the discretion to add or change the position at any time. 

Please Note:   DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process. 

The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer