Position Summary/Position

Under the direction of the Compliance Manager – Special Investigations Unit, the Compliance Specialist is responsible for monitoring and processing internal and external intake of Compliance issues, including Fraud, Waste and Abuse, HIPAA and non-compliance. The Special Investigations Unit acts as the Compliance Department’s call center and, in this role, the Compliance Specialist identifies, documents and responds to reported allegations. The Compliance Specialist also provides support to the Special Investigations Unit to investigate, track, monitor, and report activities related to planning, development, and daily operations.

Major Functions (Duties and Responsibilities)

1. Monitor all modes of intake and act as the initial point of contact , including Compliance Hotline, Compliance Mailbox, fax, mail, and internal systems.
2. Identify whether a case investigation is warranted based on information obtained during intake, if so, initiate a case, and determine the appropriate case categorization.
3. Document intake and ensure all available supporting documents are saved.
4. Identify and provide immediate notification to the Analyst and/or SIU Manager of issues which require escalation, such as potential privacy breaches
5. Conduct case investigations, research, and gather evidence on assigned cases related to routine incidents, including corrective action plans, if needed.
6. Track assigned case investigations to ensure cases are closed within internal best practice guidelines.
7. Work collaboratively with the Analyst and/or SIU Manager to provide investigative and compliance support.
8. Conduct and track monthly HIPAA Walk-throughs throughout the company to help identify privacy risks and issues. Assist with the development of Corrective Action Plans for identified issues and monitor outcomes.
9. Create DTPs specific to workflows and procedures relevant to the Special Investigations Unit responsibilities.
10. Perform a broad range of administrative duties using initiative and judgment in handling sensitive and confidential details.
11. Multi-task to coordinate, prepare and monitor special projects and reports as required.

Experience Qualifications

Three or more years of demonstrated experience in an office environment, at a professional level.

Preferred Experience

Experience in an office environment, at a professional level, preferably in a healthcare compliance function or managed care environment required.

Education Qualifications

High school diploma or GED required.

Preferred Education

Bachelor’s degree from an accredited institution preferred.

Skills Requirement

Demonstrated proficiency in Microsoft Office products (Word, Excel, PowerPoint, Outlook, etc.). Excellent interpersonal and communication skills, strong organization skills.

Ability to work independently with little direction on recurring tasks. Ability to establish and maintain effective working relationships both within and outside of the organization. Strong attention to detail.