Minimum Qualifications:
A bachelor’s degree and four (4) years of experience in an audit or investigation function are preferable.
Job Summary:
To audit and/or review complex systems or operations in order to evaluate and report on compliance matters and the adequacy, effectiveness, and comprehensiveness of compliance, accounting, management, or other controls in these operations and to ensure compliance with applicable federal and state laws, rules, and regulations.
Job Duties:
- Coordinates and conducts audits of compliance activities of UTMB departments for the Office of Institutional Compliance (OIC) to ensure compliance with applicable federal and state laws, rules, and regulations.
- Audits include compliance monitoring for the Office of Institutional Compliance, internal control, self-monitoring activities, internal education activities, investigational, and billing and coding audits with general supervision by the Chief Compliance Officer.
- Perform specialized regulatory compliance review and analysis for the Office of Institutional Compliance.
- Interacts with business administration department heads on a routine basis and establishes good work relations.
- Keeps OIC attorneys and Executive Director(s) informed of audit progress, analysis results, and efficiently manages analysis and review so that departmental quality management standards are met.
- Provides information or advice to the OIC attorneys and Executive Director(s) on regulatory compliance matters.
- Formulates ideas and finds alternative solutions to problems and improves UTMB’s processes in ensuring the institution’s compliance with applicable state and federal laws, rules, and regulations.
- Completes other job-related functions and special projects as assigned by the Chief Compliance Officer.
Functional Specialty Responsibilities:
(One or more of the following specialty areas may be assigned based on organizational need and employee expertise.)
Fraud & Abuse Hotline/Investigations:
- Coordinates and conducts investigations of compliance matters on behalf of UTMB for the Office of Institutional Compliance to ensure compliance with applicable federal and state laws, rules, and regulations.
- Investigations for the Office of Institutional Compliance, including collection of data/information, reviewing of documents, conducting interviews, compiling relevant information, and making recommendations on any findings.
- Maintains case files, documentation, data entry, and related records in accordance with institutional standards and confidentiality requirements.
- Coordinates meetings, communications, follow-ups, and status updates related to compliance reviews and case management activities.
- Monitors case activity, supports timely follow-up, and assists with reporting, trend analysis, and process improvement initiatives.
HIPAA/Privacy Compliance:
- Assists with monitoring and reviewing compliance with HIPAA, privacy regulations, institutional privacy policies, and confidentiality requirements.
- Reviews and processes privacy-related concerns, inquiries, and reported incidents for documentation, tracking, and follow-up.
- Assists with privacy compliance reviews, monitoring activities, risk assessments, and related regulatory analyses.
- Coordinates with operational departments, as appropriate, to support privacy compliance activities and corrective action efforts.
- Assists in maintaining documentation, monitoring trends, and supporting privacy education and process improvement initiatives.
Marginal or Periodic Functions:
- Adheres to internal controls and reporting structure.
- Performs other duties as assigned.
Knowledge/Skills/Abilities:
- Advanced knowledge and understanding of compliance and industry processes, practices, and regulations preferable.
- Demonstrates commitment to continued education on compliance-related issues and relevant federal and state legal authority.
- Experience with ethics, policies and procedures, training, investigations, audits, and compliance risk assessments and developing and managing compliance training and communication projects preferable.
- Ability to identify legal risk and help strike a sensible and practical balance between legal risks and business goals.
- Strong analytical reasoning skills to effectively and efficiently review, evaluate, and analyze information and data.
- Excellent collaborative skills, interpersonal skills, and written and oral communication skills.
- Demonstrated commitment to a high level of integrity and ethical principles and professionalism to uphold the compliance culture, mission, and values of the institution.
- Prior experience in a compliance-related area preferable.
- Prior experience conducting audits and/or investigations preferable.
- Goal-oriented and able to work independently once given direction.
- Strong organizational skills.
- Advanced knowledge of software application systems and spreadsheet reporting and demonstrates eagerness and aptitude to quickly learn new software/programs.
Technical and Analytical Expertise:
- Proficiency in Microsoft Excel, including complex formulas, pivot tables, and data modeling.
- Experience with statistical and data analysis tools such as RAT-STATS, SAS, R, Python, SPSS, or similar platforms for data mining, modeling, and risk analysis.
- Experience with data visualization and business intelligence tools to create impactful compliance dashboards and reports.
- Knowledge of data governance, data validation, and data quality assurance practices.
- Ability to work with large datasets from multiple systems, including electronic health records (EHR), billing systems, and compliance tracking tools.
Salary Range:
Actual salary commensurate with experience.
Working Environment:
This position is remote within Texas only. Any candidate outside of the state of Texas must be willing to relocate. Occasional onsite presence required.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.
