The Healthcare Compliance Specialist

Filled under: Healthcare Compliance on September 2012

Many organizations that work in the field of healthcare and pharmaceuticals claim that ensuring a healthcare compliance is a very complex process, but it also involves high costs. On the other hand, healthcare compliance specialists have many responsibilities:

  • monitor health and human services program operation
  • promote safety and health
  • ensure that public services are delivered properly
  • prevent fraud
  • service delivery
  • eligibility determination and payment
  • avoid risks
  • operational practices
  • medical reimbursement


The roles that these healthcare compliance specialists have are:

  • hospital quality assurance specialists
  • heath care compliance specialists
  • medical facility inspectors
  • utilization review analysts

All these occupations are healthcare compliance specialists, but each of them has a separate career track. Each of this career path involves different skills, abilities, knowledge and abilities. Selection and recruitment standards have to be based on skills, abilities and knowledge.

These roles mean also a different level of work and career progression. They are distinguished based on:

  • compensable factors of complexity
  • accountability
  • results


The Responsibilities Of A Health Care Compliance Specialist

  • applies program rules and regulations in the resolution of human services programs
  • employees conduct audits
  • provides guidance to staff, clients, public organizations
  • requires knowledge of supervisory principles and practices
  • communication with recipients, their families and with service providers
  • applies in-depth knowledge of one or more programs



A health care compliance manager requires license in a health services occupation and has more complex responsibilities:

  • directs a major organizational component of an agency
  • collaborates with federal officials and state
  • requires knowledge of forecasting and statistical methods and procedures
  • provides expert testimony for criminal, civil and administrative cases

Healthcare reform and economic pressures have made this field more complex and difficult than before. To manage these risks properly, healthcare institutions need to have great and with in-depth knowledge specialists.

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