Regulatory Compliance Specialist I

Responsibilities & Requirements

The Regulatory Compliance Specialist I supports quality patient care and adherence to federal regulations that prohibit fraud, waste & abuse of federal healthcare programs by completing billing/coding audits, providing education and supporting the return of overpayments to payers. This role remains apprised of new rules related to billing/coding issues, regulatory changes, monitors the OIG and CGS work plans and assists with dangerous drug audits. Performs other duties as assigned. All job responsibilities are to be carried out in alignment with Kettering Health's mission, vision, values, and B Safe program.

Required Education:

Bachelor's degree in healthcare administration, business administration, law, life sciences, or a related field, or equivalent combination of education and relevant experience.

Required Work Experience:

Experience (typically 0-2 years) in healthcare compliance, regulatory affairs, privacy, or a related field

experience may include internships or practicum in compliance or regulatory settings.

Required Licenses, Certifications, and Registrations:

None required.

Skills:

Knowledge of federal and state healthcare regulations (e.g., HIPAA, OSHA, other regulatory agencies). Ability to interpret and apply regulatory standards. Strong analytical, critical thinking, and problem-solving skills. Excellent written and verbal communication. Proficiency with Microsoft Office Suite and ability to learn compliance management software. Attention to detail and organizational skills. Ability to work independently and collaboratively.

Competencies:

For positions focused on Periop compliance:

Employee is trained and competent with the universal protocol

Employee is trained and competent in disaster planning

Employee is trained and competent in hand hygiene

Preferred Qualifications

Preferred Work Experience:

Experience developing or implementing compliance policies, procedures, or training in a healthcare environment.

Preferred Licenses, Certifications, and Registrations:

Certified Coder (CPC or CCS/CCS-P). Has or is able to complete and pass coding certification within 12 months of hire (CPC or CCS/CCS-P).

Work Environment:

Hybrid role - must be in the office 2 days/week.