Healthcare Compliance Specialist

Job Summary

The primary role of the Healthcare Compliance Specialist is to support the operational functions of Compliance Program Services by providing healthcare monitoring and education services for Drexel University clinical practices. The Healthcare Compliance Specialist is a regulatory expert who helps educate and advise the University toward excellence in healthcare compliance.

The Healthcare Compliance Specialist reports to the Director, Compliance Program Services.

Essential Functions

Oversee the University’s health care compliance program. Serve as primary liaison between Compliance Program Services and Drexel clinical directors and administrative leadership. Research and analyze current Medicare and Medicaid regulations applicable to the University. Maintain comprehensive knowledge of billing, reimbursement, and coding guidelines.

Perform Coding and Billing audits for Drexel Health clinical practices. Provide education and training to Physicians and clinicians to remediate audit findings and manage risk. Develop and update healthcare compliance policies and procedures, as required. Perform and review monthly screening processes against federal and state sanction databases, ensuring system confirmations and associated follow ups, as necessary.

Oversee and ensure completion of annual healthcare trainings required by Centers for Medicare and Medicaid Services. Complete and assure annual First Tier, Downstream or Related entity (FDR) attestations required by Centers for Medicare and Medicaid Services. Perform other duties as assigned by Director, Compliance Program Services and/or the Chief Compliance Officer.

Other duties as assigned Required Qualifications Minimum of a HS Diploma or GED Minimum of 3-5 years combined experience in medical auditing, academic medicine compliance, medical coding, office professional fee coding, and reimbursement. Certified Professional Medical Auditor (CPMA). Physician coding certification (CPC or CCS-P).

Exceptional ability to formulate compliance policies, procedures, and related documentation. Exceptional communication and interpersonal skills. Expert spreadsheet and database management skills. Verifiable ability to maintain the highest level of diplomacy and confidentiality.

Preferred Qualifications

Certified in Healthcare Compliance (CHC). Experience working in higher education and/or a complex organization a plus. Demonstrated ability to work effectively in teams and groups to plan, implement, and influence organizational change. Location Hybrid/Flexible Work Arrangement Additional Information This position is classified as Exempt, grade J.

Compensation

for this grade ranges from $ 52,360.00 to $ 78,530.00 per year. Please note that the offered rate for this position will vary based on the successful candidate’s qualifications and experience, department budget, and an internal equity review. Applicants are encouraged to explore the Professional Staff salary structure and Compensation Guidelines & Policies for more details on Drexel’s compensation framework.

For information about benefits, please review Drexel’s Benefits Brochure . Special Instructions to the Applicant Please make sure you upload your CV/resume and cover letter when submitting your application. A review of applicants will begin once a suitable candidate pool is identified. #LI-Hybrid