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Team Bronson is compassionate, resilient and strong. We are driven by Positivity which inspires us to be our best and to go above and beyond for our patients, for one another, and for our community.

If you’re ready for a rewarding new career, join Team Bronson and be part of the experience.

Location

BMH Bronson Methodist Hospital, Virtual

Title

Clinical Compliance Analyst

· The Clinical Compliance Analyst works with the System Director of Compliance to manage the day-to-day operation of the medical necessity compliance program and maintain a comprehensive process for an “evidence-based” compliance approach including development and maintenance of key performance indicators, project work plans and preparing necessary reports. Additionally, they lead the medical necessity auditing program. In this capacity they perform quality assurance, project planning, and generally coordinate the implementation, monitoring, and enforcement of compliance initiatives for Bronson Healthcare Group alongside their team members. Employees providing direct patient care must demonstrate competencies specific to the population served.

Bachelor of Science in Nursing Degree and RN licensure and 7-10 years of clinical nursing experience required.

Clinical experience in multiple settings preferred

• Extensive clinical background in healthcare is needed

• Strong analytical and critical thinking skills are required to assist and direct the team’s efforts in regulatory monitoring

• Proven organizational and planning skills as well as the ability to handle multiple tasks simultaneously

• Knowledge and experience in interpreting CMS guidelines and the ability to use specialized knowledge and job related experience such as billing, claims, and NCD/LCD reviews

• Exceptional customer service and communication skills with a demonstrated ability to develop and maintain outstanding customer relationships are a must

• Due to the sensitive nature of the work being performed, the ability to maintain confidentiality is imperative

• Successfully complete assignments with minimal direction and supervision

• Must be comfortable giving and receiving feedback and be comfortable presenting information to large groups of people

• Must have some basic knowledge and experience using Microsoft Word, Excel, PowerPoint and comfortable learning any other software system which may be required to achieve desired outcomes from time to time

Work which produces high levels of mental/visual fatigue, e.g., interactive and repetitive or small detailed work requiring alertness and concentration for sustained periods of time, the operation of and full attention to a personal computer or CRT between 40 and 70 percent of the time. The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.

• Coordinates implementation, monitoring and enforcement of compliance initiatives for Bronson-employed physicians and hospital departments, to comply with applicable laws as they relate to billing procedures and requirements.

• Provide guidance to team members and less experienced staff; function as a lead worker and/or head project teams.

• Reviews the clinical documentation practices of all BHG employed physicians as part of the Corporate Compliance Program and make the necessary recommendations to ensure the claims are compliant and to minimize the exposure to monetary penalties.

• Reviews the clinical documentation practices for all Bronson Healthcare Group facility departments as part of the Corporate Compliance Program and make the necessary recommendations to ensure the claims are compliant and to minimize the exposure to monetary penalties.

• Responds to questions, issues and reports of potential issues in coordination with System Director and/or Chief Compliance Officer.

• Independently assesses critiques and makes authoritative recommendations for revisions to physicians and hospital coding and documentation techniques and policies. Monitors such on an ongoing basis and ensures that approved recommendations are implemented.

• Assists with training and education related to corporate compliance to physicians and hospital departments.

• Interacts frequently with the System Compliance Director and is an active member of the Medical Appropriateness Committee.

• Participates in yearly OIG Audit Plan by auditing and reviewing any Bronson Healthcare Group risk factors.

• As requested, participates with any third party (MPRO, BlueShield/BlueCross, Medicare, Medicaid) audit for the hospital or hospital employed physicians.

• Job Title Default

Job Title Default

Clinical Compliance Analyst

• Restrict to Country

Restrict to Country

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• Management Level

Management Level

• Non-Manager

• Job Level

Job Level

• Non-Management Professional

Shift

First Shift

Time Type

Full time

Scheduled Weekly Hours

40

Cost Center

1235 Compliance (BHG)

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