Rochester Regional Health
Compliance Coordinator – Rochester Regional Health
Full-time, 40 hours/week, Day Shift, Remote (Riedman)
Job Summary Senior Corporate Compliance Coordinator plays a critical role in minimizing organizational risk by conducting comprehensive compliance audits, investigations, and training across all affiliates. The position provides guidance to system administration and management to ensure adherence to local, state, and federal laws, regulatory requirements, and contractual obligations. Serving as a subject matter expert, the Coordinator leads efforts to build and continuously optimize the organization’s electronic medical record (EMR) system. Additionally, this role mentors and trains less experienced staff, offering support in resolving complex issues, technical challenges, and compliance‑related questions.
Responsibilities
Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
Provides guidance and general oversight to less experienced employees and trains new employees.
Manages projects independently, prepares governmental disclosures, and facilitates external audits by regulatory agencies when requested.
Coordinates and conducts audits to assess compliance with payer regulations and contract obligations, including revenue cycle, financial statements, and employee screening.
Conducts staff interviews with professionalism to determine root causes of identified issues.
Collaborates to discuss audit findings and offer advice and education to improve compliance.
Develops reports reflecting audit results and reports findings to Compliance leadership and management.
Develops corrective action plans with Management and assists with implementation when necessary.
Performs follow‑up audits to ensure controls are implemented and effective.
Analyzes compliance studies prepared by government and professional associations to assess risk and opportunity for assigned departments.
Identifies compliance benchmarks for assigned areas and performs risk assessment analysis.
Collaborates regularly with management to keep them informed of regulatory changes that may impact their departments.
Conducts research and supports Compliance leadership in initiatives related to new business growth across the system.
Collaborates with system management on margin improvement initiatives, granting approvals as needed, and provides training to staff involved in implementation to ensure compliance.
Serves as a subject matter expert in the ongoing development and optimization of the system’s EMR, focusing on clinical documentation, workflows, and revenue cycle impacts to ensure compliance. Delivers presentations to clinicians on proper documentation practices within the EMR.
Designs and implements training to ensure compliance with the revenue cycle focusing on clinical documentation, coding, charging, billing, and denial appeals for physicians, health care providers, HIM coders, and other applicable employees.
Performs and manages internal investigations into reports of non‑compliance (fraud, waste, and abuse) by employees or external sources as directed. Interviews system management and staff with respect and professionalism.
Facilitates and manages, under the general direction of Compliance Leadership, external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare, and third‑party payer fraud units.
Required Qualifications
AAS or BS in Health Information Management, Health Care Administration, or related field, with experience in healthcare compliance.
Minimum five years of healthcare experience, including at least three years of health‑care compliance experience.
Five years of progressive healthcare coding experience preferred, with extensive knowledge of ICD‑10‑CM/PCS and CPT coding, reimbursement systems, and federal, state, and payer‑specific regulations.
Formal training in auditing preferred.
Required Licensure/Certification Skills
RHIT, RHIA, CCS, CCS‑P or applicable AAPC certification.
Other relevant healthcare certifications considered in lieu of the above.
Compliance Board Certification a plus.
Physical Requirements Sedentary work – Exerting up to 10 pounds of force occasionally. May involve walking or standing for brief periods. Jobs are sedentary if walking and standing are required only occasionally.
Pay Range $66,000 – $82,000
Equal Employment Opportunity Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.
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Full-time, 40 hours/week, Day Shift, Remote (Riedman)
Job Summary Senior Corporate Compliance Coordinator plays a critical role in minimizing organizational risk by conducting comprehensive compliance audits, investigations, and training across all affiliates. The position provides guidance to system administration and management to ensure adherence to local, state, and federal laws, regulatory requirements, and contractual obligations. Serving as a subject matter expert, the Coordinator leads efforts to build and continuously optimize the organization’s electronic medical record (EMR) system. Additionally, this role mentors and trains less experienced staff, offering support in resolving complex issues, technical challenges, and compliance‑related questions.
Responsibilities
Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
Provides guidance and general oversight to less experienced employees and trains new employees.
Manages projects independently, prepares governmental disclosures, and facilitates external audits by regulatory agencies when requested.
Coordinates and conducts audits to assess compliance with payer regulations and contract obligations, including revenue cycle, financial statements, and employee screening.
Conducts staff interviews with professionalism to determine root causes of identified issues.
Collaborates to discuss audit findings and offer advice and education to improve compliance.
Develops reports reflecting audit results and reports findings to Compliance leadership and management.
Develops corrective action plans with Management and assists with implementation when necessary.
Performs follow‑up audits to ensure controls are implemented and effective.
Analyzes compliance studies prepared by government and professional associations to assess risk and opportunity for assigned departments.
Identifies compliance benchmarks for assigned areas and performs risk assessment analysis.
Collaborates regularly with management to keep them informed of regulatory changes that may impact their departments.
Conducts research and supports Compliance leadership in initiatives related to new business growth across the system.
Collaborates with system management on margin improvement initiatives, granting approvals as needed, and provides training to staff involved in implementation to ensure compliance.
Serves as a subject matter expert in the ongoing development and optimization of the system’s EMR, focusing on clinical documentation, workflows, and revenue cycle impacts to ensure compliance. Delivers presentations to clinicians on proper documentation practices within the EMR.
Designs and implements training to ensure compliance with the revenue cycle focusing on clinical documentation, coding, charging, billing, and denial appeals for physicians, health care providers, HIM coders, and other applicable employees.
Performs and manages internal investigations into reports of non‑compliance (fraud, waste, and abuse) by employees or external sources as directed. Interviews system management and staff with respect and professionalism.
Facilitates and manages, under the general direction of Compliance Leadership, external investigations into the system by agencies such as OIG, DOJ, OMIG, FBI, Medicare, and third‑party payer fraud units.
Required Qualifications
AAS or BS in Health Information Management, Health Care Administration, or related field, with experience in healthcare compliance.
Minimum five years of healthcare experience, including at least three years of health‑care compliance experience.
Five years of progressive healthcare coding experience preferred, with extensive knowledge of ICD‑10‑CM/PCS and CPT coding, reimbursement systems, and federal, state, and payer‑specific regulations.
Formal training in auditing preferred.
Required Licensure/Certification Skills
RHIT, RHIA, CCS, CCS‑P or applicable AAPC certification.
Other relevant healthcare certifications considered in lieu of the above.
Compliance Board Certification a plus.
Physical Requirements Sedentary work – Exerting up to 10 pounds of force occasionally. May involve walking or standing for brief periods. Jobs are sedentary if walking and standing are required only occasionally.
Pay Range $66,000 – $82,000
Equal Employment Opportunity Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.
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