POSITION DESCRIPTION

POSITION SUMMARY: Helps ensure that WVUH and other entities within the health system (WVUHS), University Health Associates, Allied Health Solutions, the ACO of WV, and all others as required by federal regulation remain in compliance with federal and state requirements

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.

High School diploma or equivalent.

EXPERIENCE:

1.

Five (5) years of experience in a healthcare organization.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1.

For WVUHS (including WVUH), UHA, Allied Health Solutions, ACO of WV, and all others as required by federal regulation, performs the exclusion screening and verification process for all employees(approximately 28,000), physicians, board members (both facility and foundation) vendors, and external referring physicians to ensure compliance with the federal and state regulations, including coordination of reporting from all facilities, sanction/exclusion screening (2 federal databases and 25+ state databases), follow-up and resolution for all potential matches. Failure to identify an excluded individual and/or entity will result in significant repayment and/or penalties.

2.

Completes provider-based department/clinic walkthroughs to ensure compliance with the Centers for Medicare and Medicaid Services requirements, including quarterly visits to provider-based departments, initiates deficiency correction, and documentation on the work plan. Failure to comply with the CMS requirements could result in significant paybacks, fines, penalties, and the loss of provider-based status.

3.

Completes audits of the Place of Service for provider-based departments/clinics to insure UHA and WVU claims are submitted with the appropriate place of service to insure accurate claim submission. Failure to submit accurate claims could result in significant paybacks, fines, penalties, and the loss of provider-based status.

4.

Monitors the completion of the annual Conflict of Interest process for the WVUHS Board of Director members, each WVUHS affiliated entity Board of Director Members, Allied Health Solutions Board of Director members, the ACO of WV Board of Director members and the Board of Director members for each Foundation associated with the WVUHS. The analyst compiles the disclosed information from each form into a database for executive level dissemination and review.

5.

Provides administrative assistance to the Corporate Compliance department by completing assigned tasks, including but not limited to, drafting and sending correspondence, maintaining appropriate department records and files, distribution of mail, distribution of faxes, responding to email correspondence, and requisition of office supplies.

6.

Utilizes various personal computer applications (i.e., spreadsheets, databases, communications software, desktop publishing software and word processing software) to support the department.

7.

Maintains (additions, deletions, revisions) the Corporate Compliance departmental website (on CONNECT) for WVUH and UHA to reflect annual and ongoing updates. Plays a key role in the development of new departmental/system-wide websites based on growth and centralization.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.

Extended periods of sitting.

2.

Extended periods of computer and telephone usage.

3.

Must be able to move throughout the department work areas.

4.

Must have clarity of speaking and hearing.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.

Standard office environment

SKILLS AND ABILITIES:

1.

Excellent organizational and time management skills.

2.

Excellent written and interpersonal communication skills.

3.

Ability to utilize electronic medical record and billing systems.

4.

Ability to work independently and manage multiple priorities and deadlines.

5.

Ability to analyze and summarize written information in a spreadsheet.

6.

Ability to complete tasks in a cyclical and timely manner to ensure regulatory compliance and meet required deadlines.

Date Reviewed/Revised: April 2022