Compliance Specialist

The Villages, FL

Full Time

6503 Powell Road, The Villages, FL

Experienced

Please note the position is not remote (on-site).

About The Villages Health
The Villages Health is a patient-centered primary care driven, multi-specialty medical group with over 800 team members. Our unique care model gives us both the time and resources to truly care for our patients, along with a company culture that supports a healthy work-life balance for our team members. Our purpose, mission and vision is to empower Villagers and the surrounding communities to live out their dreams by keeping them healthy and healing them quickly. Together, we are changing the way healthcare is delivered and are making a positive difference in the lives of our patients and the communities we serve. In doing so, The Villages Health is creating America’s Healthiest Hometown.

Our Full-time Benefits
Medical, Dental & Vision Insurance | Matching HSA & 401k | PTO & Paid Holidays | The Villages Charter School Eligibility | & much more!

Hiring Event
Please bring your resume and join us:

Friday, August 15^th from 9:30 AM to 1:30 PM at The Villages Health Administrative Office (6503 Powell Road, The Villages, FL 32163) – RSVP’s are encouraged through Eventbrite at https://bit.ly/4jOlUm2

Responsibilities:
The Compliance Specialist shall be responsible for supporting The Villages Health (“TVH”) Chief Compliance Officer (“CCO”) and Compliance Department in implementing the TVH Compliance Program. The Compliance Specialist shall be a full-time employee, reporting directly to TVH’s CCO.

Essential Duties and Responsibilities:
Duties and Responsibilities may include, but are not limited to:

Assisting in the development, revision, and implementation of Compliance Policies and Procedures (P&Ps”) and supporting protocols required to maintain compliance with federal and state healthcare program requirements, health plan contracts, and accreditation requirements.
Supporting the CCO in the annual, comprehensive Compliance Risk Assessment
Assisting with routine auditing and monitoring protocols
Ensuring dissemination and completion of compliance education and training programs on general compliance topics as well as fraud, waste, and abuse (“FWA”), Health Insurance Portability & Accountability Act (“HIPAA”) Privacy & Security, and coding and billing compliance.
Partnering with Learning & Development and department leadership on implementing and conducting Compliance training to staff including, but not limited to, physicians, clinical/non-clinical staff, operations, and administrative staff.
Assisting CCO with operationalization of all compliance-based initiatives.
Communicating effectively with other departments within TVH and ensuring prompt response and resolution to compliance related issues or concerns.
Supporting the CCO in creating reports for the TVH Compliance Committee, Compliance Committee of the Board, and TVH’s Board of Directors.
Maintaining knowledge of industry standards and regulatory changes related to compliance in healthcare.
Partnering with TVH to provide any compliance-related support, as required.
Fostering a culture of open communication promotes a culture of compliance.
On-site work Monday through Friday required.

Education/Experience Requirements:

Bachelor’s degree and at least 2 years of experience in a healthcare compliance role, preferably with large physician practices contracted with Medicare Advantage; or
Associate’s degree and 4 years of experience in a healthcare compliance role, preferably with large physician practices contracted with Medicare Advantage.
Certification in Healthcare Compliance (CHC), Healthcare Privacy Compliance (CHPC), Health Care Compliance Association (HCCA) membership, and/or course accreditation from HCCA or similar organization preferred.
Knowledge of regulatory requirements and industry leading practices for compliance programs. This includes knowledge of the seven elements of compliance, as required by the U.S. Department of Health & Human Services, Office of Inspector General (“OIG”) and other regulatory agencies.
Knowledge of risk adjustment rules, regulations, and guidance.
Knowledge of physician incentive and compensation programs.
Knowledge of HIPAA Privacy & Security, including practical application within a healthcare organization.
Knowledge and practical application of the healthcare fraud and abuse laws, rules, and regulations, including the Anti-Kickback Law, the Physician Self-Referral Law (“Stark Law”), the False Claims Act (as related to documentation, coding, and billing), and applicable Florida state regulations.
Excellent communication and analytical skills.
Strong problem-solving abilities.
Ability to seamlessly work in complex environments, including interacting with physicians, clinical/non-clinical support staff, operations, and administrative staff.

Salary is commensurate with experience.

Questions? Contact us at [email protected]

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I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions, or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.

I understand that The Villages Health is an equal opportunity employer and does not unlawfully discriminate in employment and this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment.

I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.

I hereby authorize The Villages Health to contact, obtain, and verify the accuracy contained in this application. I authorize all persons, educational institutions, corporations, companies, agencies, and references to supply any information concerning my background. This includes authorizing the release of information about non-judicial punishment that might have occurred in any branch of the military service. If an official background check of my credit and criminal history is needed, a separate Disclosure Statement and Authorization will be provided to me.

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Compliance Specialist

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