University of Utah Health Research · 4 hours ago
Regulatory Compliance Administrator Hybrid/Remote
Salt Lake City, UT
Full-time
Hybrid
Mid, Senior Level
$78K/yr - $100K/yr
3+ years expUniversity of Utah Health Research is seeking a Regulatory Compliance Administrator to collaborate with providers, managers, and staff to implement and monitor compliance practices. The role involves conducting audits, developing policies, and ensuring adherence to regulatory guidelines.
Higher Education
Responsibilities
Maintains current knowledge regarding federal and state guidance, organizational needs, and regulations
This position prioritizes governmental and internal audit requests and needs based on risk, timelines, and available skilled personnel
Reviews documentation for medical necessity and utilizes industry standard tools such as InterQual or Milliman
Teams with providers and staff to assist departments in implementing compliance practices and monitors and coordinates those activities with the departments
Assists the University in preparing and completing regulatory audits by developing, monitoring, and updating quality controls and recommending actions to maintain compliance
Oversees, coordinates, and conducts audits/investigations to ensure compliance with University, State, and Federal guidelines
Analyzes and documents compliance processes. Recommends enhancements to policies and procedures for compliance review
Designs and implements training and education programs to enhance compliance awareness
Serves as an expert resource in compliance issue resolution
Qualification
Required
Current licensure to practice as a Physician's Assistant in the State of Utah and minimum three years of experience in a patient care capacity OR current licensure to practice as a Registered Nurse ( BSN or APRN ) in the State of Utah and minimum five years of experience working in a patient care capacity or equivalency (one year of education can be substituted for two years of related work experience)
Patient care experience may be substituted with equivalent years of experience in medical necessity review
Must be proficient with word processing, spreadsheet and related computer applications
Exemplary human relations and effective communication skills
Requires a sound knowledge of clinical practice and exceptional critical thinking and leadership abilities
Department may require coding certification ( CPC , ACS , CCS -P/H, RHIA , or RHIT )
Preferred
Knowledge of utilization review and quality assurance procedures, as well as experience with InterQual or Milliman and Case Management procedures of medical necessity auditing
Bachelor's Degree in Health Care Administration, Business Administration, or a related field, or the equivalent
Knowledge of medical auditing, Federal healthcare program policies and requirements (including Medicare Parts A and B), and ICD -10, CPT , HCPCS , DRG coding
Coding certification ( CPC , CPC -H, ACS , CCS -P/H, RHIA ). If not current, must be willing to obtain within the first six months of employment
Certified in Healthcare Compliance ( CHC ) from the Health Care Compliance Association ( HCCA ). If not current, must be willing to obtain within the first six months of employment
Benefits
The University is a participating employer with Utah Retirement Systems (“URS”). Eligible new hires with prior URS service, may elect to enroll in URS if they make the election before they become eligible for retirement (usually the first day of work).
Company
University of Utah Health Research
At University of Utah Health, our world-class researchers work together to tackle some of the toughest problems in health and medicine.
5001-10000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase