RN Compliance Specialist

Position will conduct general and focused audits of clinical documentation to determine completeness, consistency and appropriateness of documentation in the clinical record and compliance with applicable laws, regulations, CMS Conditions of Participation, documentation in meeting Local Coverage Determinations (LCD) and SFR policies and standards. Key expectations are identification of areas of clinical risk, development of recommendations for mitigation of those risks, participation in development and implementation of education and training of clinical staff related to the identified risks and full participation in the St. Francis Compliance Program.

REPORTS TO: Director of Compliance

EDUCATION AND/OR TRAINING REQUIRED:

Registered Nurse, required. Bachelor's degree in Nursing preferred.

CERTIFICATIONS/LICENSES REQUIRED:

Valid Florida Registered Nurse License. Unrestricted State of Florida Driver License

EXPERIENCE/SPECIFIC SKILLS AND ABILITIES REQUIRED:

Two years' experience in a healthcare organization and a minimum of one year in a hospice, with an in depth knowledge of Hospice Conditions of Participation (COPs). Past experience in hospice medical record review preferred. Facile in utilizing electronic medical records in decision making. Possess strong analytical skills. Excellent communication skills with the ability to interact with the staff in an instructional but nonjudgmental manner. Exceptional organizational ability and attention to detail.

PHYSICAL REQUIREMENTS: Ability to lift, push, pull twenty five (25) pounds without difficulty; able to work extended hours as required under various work environments and work under varying levels of stress.

PRIMARY RESPONSIBILITIES:

• Maintain and apply current knowledge of standards of care in clinical documentation
• Audit clinical charts for evidence of decline. Ensure documentation due to terminal prognosis and provide summary of findings on quality of documentation in "documenting to the terminal diagnosis"
• Participates in chart audits and subsequent one-on-one training with employees to ensure ongoing compliance in all aspects of agency operations
• Developing, coordinating, and participating in a multifaceted educational and training program that focuses on the elements of the clinical compliance program, and seeks to ensure that all appropriate employees and management are knowledgeable of, and comply with, pertinent federal and state laws and regulations.
• Assist with special compliance/quality educational training as requested.
• Analyze reports to spot trends.
• Complete observational visits with staff and assess their documentation of the visit and provide feedback to the staff member.
• Responding to requests for clinical records from governmental bodies as the responsible party to respond.
• Independently investigating and acting on matters related to clinical compliance, including the flexibility to design and coordinate internal investigations.
• Monitoring external audit review processes, maintains awareness of compliance issues.
• Participate as an active supporter of the St. Francis Hospice compliance program including the emphasis to report, while complying with all Federal, State, and Local laws as well as the organization's compliance program. Serve on the organization's Compliance Committee.

SECONDARY RESPONSIBILITIES:

• In conjunction with senior management, responds to administrative inquiries related to compliance issues or audits.
• Working with the education department, develops an appropriate effective training program for new employees and ongoing training for all employees.
• Other duties as assigned.
• Attendance is a condition of employment.

COMPLIANCE:

Exhibits knowledge of organizational policies, and state and federal laws and regulations consistent with duties and responsibilities. Demonstrates high ethical standards and compliance with organizational standards.

QUALITY:

Actively participates in the Quality Assessment Performance Improvement program by identifying opportunities for improvement and by participating in performance improvement activities. Demonstrates the ability to apply customer service techniques to facilitate improved outcomes with internal and external customers.

Equal Opportunity Employer

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