Doctors and other health care providers must comply with government rules and regulations designed to protect the rights of patients and to prohibit fraudulent activities. Requirements can increase or change as new or modified regulations become law. For example, the Patient Protection and Affordable Care Act of 2010 requires doctors who treat Medicare and Medicaid patients to have compliance programs. Skilled professionals work with physicians to manage compliance for their practices. These medical compliance specialists plan, develop and implement compliance programs and monitor program effectiveness.
What They Do
Medical compliance specialists conduct activities that ensure compliance with legal requirements. They review and evaluate medical protocols, coding and billing practices to assess compliance status. Specialists also evaluate staff education needs and recommend and conduct training related to compliance protocols and procedures. Medical compliance specialists routinely complete audits and reviews to monitor compliance. If deficiencies are found during an audit, compliance specialists recommend corrective actions and follow-up to make sure problems are resolved.
What They Know
Medical compliance specialists must be familiar with the health care laws specific to the practice they serve. Examples include laws governing third-party medical billing, patient privacy and health care fraud. The must know how to research these laws, determine compliance needs and develop compliance recommendations. To do this effectively, medical compliance specialists need strong analytical skills, effective communication skills and knowledge of a variety of software applications and research tools to boost their efficiency and timeliness in getting the job done.
Getting started as a medical compliance specialist requires a bachelor’s degree in either health care, business administration or in a field related to regulatory compliance. Specialists with three to five years of experience working with health care insurers or third-party billing establishments will have coding and billing experience needed for a compliance evaluation and monitoring position. Becoming a certified medical compliance officer may boost credentials of compliance specialists because of the comprehensive exam requirements.
The average salary for medical compliance specialists saw a downward trend between 2011 and 2013. Even so, depending on job location, industry sector and other factors, medical compliance specialists can expect to earn an average annual salary of $51,000, according to recent salary data from Indeed.com. This average salary is based on nationwide job postings. In comparison, the average salaries of related compliance jobs range from $21,000 for a Medicaid specialist to $73,000 for a regulatory affairs specialist.
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