What Are Some of the Typical Positions in Healthcare Compliance?

Compliance jobs exist across many industries, but job duties and responsibilities for them are remarkably similar, regardless of where you work. They all pursue a similar goal—for an organization to be run legally and ethically, in compliance with all applicable industry regulations. Here some of the typical positions representative of a healthcare compliance program:

Compliance Officer

From the top of the compliance pyramid, the compliance officer leads the development and management of an organization’s compliance program. Not only does this person implement significant recommendations from compliance audits and risk assessments; he or she also incorporates industry best practices to ensure adherence with all governmental standards. One vital component of ensuring compliance is training—the compliance officer takes the lead in providing compliance training and education programs for healthcare staff and tracks completion of that training. This person often serves as the face authority for compliance information to management and senior leadership. The person in this position works with the legal department or chief legal counsel and the finance department to keep tabs on high-risk areas, respond to identified issues, and intervene as necessary to prevent problems.

Depending on the scale and breadth of an organization, a team of compliance-focused staff is necessary to meet compliance responsibilities and support the compliance officer. The involved positions may require special training and experience, up to a graduate degree, such as an MBA or law degree. According to Michigan State University, “The Bureau of Labor and Statistics projects the need for compliance officers to continue to grow by over 8% from 2016 through 2026” (MSU, 2018).

Compliance Analyst

A compliance analyst focuses on data and analyzes it to assess compliance activities. From identifying risk areas to protecting patient information, the compliance analyst assists the efforts of compliance leadership with the information to support decision-making. This person “needs to present conclusions and recommendations from the analytics, which could include opportunities for intervention, recommending more efficient processes and identifying shifts in patient data. Communication is key, as this complex data analysis needs to be presented in an easily understandable manner” (MSU, 2018). The compliance analyst must have superior skills at documentation and keep accurate records of data, reporting, all compliance team activities, as well as organization communications about compliance, in case they need to be shared with regulators and auditors. For this position, “an analytical mindset, critical thinking skills, and experience with healthcare information systems are all beneficial” (MSU, 2018).

Compliance Auditor

The compliance auditor looks for evidence of compliance on the frontlines of healthcare. This can involve reviews, monitoring, and examination of all internal policies andprocedures. Often this position engages in regular, periodic patient record and billing audits, to assess processes and the compliance of individual staffers and departments. Findings often lead to improvement in internal procedures. An accounting or legal background can be helpful in this position, as can an ability to work collaboratively.

Patient Privacy and Protection Specialist

The patient privacy and protection specialist is often an expert on the requirements of HIPAA (Health Insurance Portability and Accountability Act of 1996), the United States legislation that provides data privacy and security provisions for safeguarding medical information. A great deal of attention is normally given to how secure information and records systems manage “sensitive and confidential patient information, including medical records, authorization forms and personal financial and billing records” (MSU, 2018). Safeguarding information security is a crucial part of this role, which involves system reviews, risk assessments, investigations, and audits to ensure protection of confidential patient information. They may also monitor access within the organization or by third parties to systems and records. This person needs to stay abreast of healthcare privacy best practices and the latest trends in privacy training.

As a special note, all of the roles in the compliance pyramid benefit greatly from Healthcare Compliance Software. The Best Healthcare Compliance Software include specific features for Data security and privacy, Training and education tools, Policy management, Risk management tools, Reporting and analytics, Integration capabilities.