Careers at Sagility

Educational Qualifications: High School Diploma

Professional Qualifications: A Junior Healthcare Compliance Specialist supports the development and implementation of compliance programs within a healthcare organization. They assist in ensuring adherence to relevant laws, regulations, and internal policies, and may conduct audits, monitor compliance, and contribute to training programs. Responsibilities include maintaining documentation, assisting with investigations, and staying updated on regulatory changes. 

Language: English

Summary of Experience: Understanding of laws and regulations that affect the industry you work in. You will also need to have strong analytical, problem-solving, and communication skills, to be able to identify risk areas and communicate risks to different stakeholders.

Mandatory Skills: Evaluating existing policies and procedures, identifying gaps and areas that need improvement.
Developing and implementing compliance programs that encompass laws and regulations relevant to the organization’s operations.
Conducting assessment and analysis of potential risks and developing risk management strategies.
Investigating reported cases of non-compliance and developing corrective measures to prevent reoccurrence.
Educating employees on their roles and responsibilities in compliance with company policies and regulations.
Ensuring that internal audit procedures align with regulatory requirements and identifying areas that need improvement.

Preferred Skills:

Experience with compliance software or tools, Knowledge of risk assessment methodologies, and Experience with data analysis. 

Purpose of the Role

A Junior Compliance Analyst’s primary role is to assess and monitor the organization’s activities for compliance with various legal and ethical requirements. This could be working with all organizational teams, both client facing and non-client facing to identify compliance with regulations and laws applicable to Sagility’s lines of business and all US Federal, State and CMS regulations at a minimum for unusual billing practices. The person in this role might also dig into accidents or incidents and their related operations and non-compliances. They are a pivotal part of the team to ensure strict adherence to local, federal, and state government regulations.

Regulatory Compliance: They monitor and interpret federal, state, and local healthcare laws and regulations to ensure the organization is following them correctly. This includes regulations related to patient privacy (HIPAA), operational risk (CMS regulations), fraud and abuse laws, and more.
Detect Fraud: This role will review reports and even compliance data to uncover corruption and fraud and non-compliance with company policies and processes.

Roles & Responsibilities:

Detailed Responsibilities
• Assist in conducting regular CMS and HIPAA Mock audits with oversight from the Compliance Director/Manager to ensure compliance with healthcare regulations are being met across all departments within the geographic organization.
• Assist and implement compliance programs and policies and monitor policies ongoing for compliance and adherence from internal departments.
• Provide training to staff on compliance issues and best practices.
• Monitor changes in healthcare laws and regulations.
• Identify potential compliance risks and implement corrective actions and report to senior leadership.
• Collaborate with various departments to ensure compliance across the organization in respects to healthcare compliance as well as alignment with client requirements to provide oversight and spot auditing.
• Report and assist Special Investigations Unit in preparing and submission of compliance reports to compliance leadership for incidents as needed.
• Investigate and resolve compliance issues and complaints working with senior management.
• Maintain accurate outcomes and evidence records of compliance activities via auditing tools.
• Assist in the development of internal controls and procedures.
• Review and update compliance documentation as needed.
• Conduct Vendor oversight activities to ensure CMS compliance through attestation request and review.
• Ensure that all staff are aware of and adhere to compliance policies for Sanction Screening, CMS auditing, Vendor requirements, HIPAA, HHS, all US State and Federal Requirements.
• Stay current with industry trends and best practices in healthcare.