Remote Merchant Risk Analyst Jobs in Franklin, TN

Key Responsibilities

Promote Compliance Across the Organization

• Participate in implementing the Surgery Partners Compliance and Ethics Program across assigned Division facilities.
• Assist with the planning, design, implementation, and monitoring of compliance initiatives.
• Promote adherence to the Surgery Partners Code of Conduct, Compliance and Ethics Program, and all applicable healthcare laws, regulations, and company policies.
• Partner with facility leadership and market leaders to conduct risk assessments, develop policies and procedures, provide compliance training, support investigations, conduct regulatory reviews, and perform auditing and monitoring activities.
• Serve as a point of contact for compliance concerns and potential violations, escalating issues to the Division Compliance Officer and/or Chief Compliance Officer as appropriate.
• Assist in developing, maintaining, implementing, and revising compliance-related policies, processes, procedures, and documentation.
• Collaborate with Legal, Operations, and other departments to ensure awareness of regulatory requirements and recommend improvements to facility policies and processes.

Monitoring and Auditing

• Maintain a strong understanding of healthcare law, revenue cycle management, and compliance-related research methodologies.
• Conduct investigations and ensure timely follow-up on Compliance Hotline reports and other compliance concerns.
• Execute audit plans to verify adherence to compliance policies and procedures.
• Support exclusion screening and monitoring activities in coordination with Human Resources and investigate potential federal or state exclusion matches.
• Monitor daily compliance activities across Division facilities and analyze data to identify potential compliance risks.
• Perform compliance audits, coordinate responses, prepare reports, and provide recommendations to Division and facility leadership.
• Review and update compliance policies, contracts, and related documentation to ensure alignment with applicable federal, state, and industry regulations.
• Serve as Interim Hospital Compliance Officer when needed during periods of local leadership vacancies.

Compliance Education

• Provide compliance consultation and education to facility staff.
• Assist in developing and delivering compliance training for employees, medical staff, and contractors.
• Monitor training completion and compliance with training requirements.
• Research and analyze regulatory changes, payer requirements, and industry guidance, communicating updates to operational teams.

Issue Tracking

• Participate in Compliance Operations meetings.
• Track, research, document, and support resolution of compliance-related issues.
• Maintain logs of compliance inquiries and outcomes raised by leadership, employees, business partners, and auditors.

Collaboration and Leadership

• Adhere to all company policies, procedures, and the Code of Conduct.
• Support cross-functional compliance initiatives and special projects.
• Collaborate with operational leaders to resolve compliance and regulatory concerns.
• Communicate regularly with internal stakeholders to ensure timely completion of audits and corrective actions.
• Serve as a compliance and reimbursement resource for management and staff.
• Provide guidance regarding billing compliance matters.
• Assist in the development and implementation of compliance policies and procedures.

Other Responsibilities

• Support the Division Compliance Officer with risk assessments, compliance planning, auditing, and program development.
• Analyze compliance and operational risks across facilities.
• Travel domestically as needed (up to 25%).
• Perform other duties as assigned.

Performance Expectations

• Demonstrate Surgery Partners values and adherence to the Code of Conduct.
• Maintain regular and reliable attendance.
• Maintain required licenses and certifications.
• Apply knowledge of HIPAA, The Joint Commission, OSHA, AAPC, and other healthcare regulations.
• Complete annual training and competency requirements.
• Understand compliance requirements related to federally funded healthcare programs, including Medicare and Medicaid fraud, waste, and abuse regulations.
• Escalate compliance concerns and take appropriate action when issues are identified.

Qualifications

Education

Required:

• Bachelor's degree in Business Administration, Health Information Management, Health Administration, or a related field.
• Equivalent relevant experience may be considered in lieu of education.

Preferred:

• Master's degree in Accounting.
• Juris Doctor (JD).

Experience

Required:

• Minimum of 5 years of experience as a mid- to senior-level healthcare compliance professional.

Licenses and Certifications

Required:

• Valid driver's license for business travel.

Preferred:

• Certified in Healthcare Compliance (CHC).
• Licensed attorney with healthcare experience in a law firm or in-house legal department.
• Certified Public Accountant (CPA) with experience in healthcare revenue cycle or business office operations.

Knowledge, Skills, and Abilities

Communication

• Strong verbal and written communication skills.
• Ability to prepare business correspondence and presentations.
• Effective communicator with employees, facility leaders, executives, vendors, and external stakeholders.

Critical Thinking

• Ability to identify and resolve complex issues using sound judgment.
• Experience analyzing financial and operational data.
• Ability to interpret business, regulatory, and industry information and understand its impact on organizational operations.

Leadership and Interpersonal Skills

• Ability to influence and collaborate across multiple levels of the organization.
• Team-oriented with strong relationship-building skills.
• Ability to explain complex compliance concepts to diverse audiences.

Professionalism

• Handles highly sensitive and confidential information with discretion.
• Demonstrates professionalism, credibility, and integrity.

Project Management

• Strong organizational and prioritization skills.
• Ability to manage multiple projects and deadlines in a fast-paced environment.
• Works effectively both independently and collaboratively.

Technical Skills

• Proficiency in Microsoft Office applications and other applicable software.
• Strong analytical and quantitative skills.
• Ability to read, write, and communicate effectively in English.

Additional Requirements

• Ability to use standard office equipment.
• Continuous assessment of legal, regulatory, operational, financial, and reputational risks across hospitals, ambulatory surgery centers, and physician practices.
• Willingness to travel by air as necessary.

Working Conditions

Physical Requirements

• Frequent speaking, hearing, and visual observation.
• Ability to sit, stand, and walk for extended periods.
• Regular use of hands and fingers for computer and office-related tasks.
• Occasional climbing, balancing, bending, stooping, kneeling, crouching, crawling, reaching, twisting, pushing, and pulling.

Physical Demand Level

• Sedentary work involving exertion of up to 10 pounds of force occasionally.
• Primarily seated work with occasional walking and standing.

Work Environment

• Standard office environment.
• Exposure to healthcare settings where appropriate precautions must be followed.

OSHA Classification

• Category II: Routine duties generally do not involve exposure to blood or bodily fluids; however, potential exposure may occur.

Protected Health Information (PHI)

• This position requires access to Protected Health Information (PHI).

Supervisory Responsibilities

• No supervisory responsibilities.

Disclaimer This job description is not intended to be an exhaustive list of duties, responsibilities, or activities. Responsibilities may change or additional duties may be assigned at any time, with or without notice.

Benefits:

• Comprehensive health, dental, and vision insurance
• Health Savings Account with an employer contribution
• Life Insurance 
• PTO
• 401(k) retirement plan with a company match
• And more! 

ENVIRONMENTAL/WORKING CONDITIONS: Normal busy office environment with much telephone work. Possible long hours as needed. The description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

*If you are viewing this role on a job board such as Indeed.com or LinkedIn, please know that pay bands are auto assigned and may not reflect the true pay band within the organization.

*No Recruiters Please