Working in Healthcare Compliance

Working in Healthcare Compliance


Compliance jobs don’t tend to vary too much between industries. Certainly, the fundamental goals and responsibilities are universal in ensuring the legal and ethical compliance of the organisation as well as keeping it aligned with all applicable industry regulations. If you want to work in healthcare compliance, you can expect the role to cover most obvious bases but there are additional points to be aware of.

A healthcare compliance professional must know the laws and regulations pertaining to healthcare facilities, inside and out. They are the go-to person for conducting investigations and audits to identify areas of risk as well as strategizing on plans to improve compliance practices in response to those risks and monitor them once in operation to ensure best practices are being followed.

Education and training are also key components of what it means to work in healthcare compliance. A compliance officer will be expected to head up specific programs for healthcare staff to ensure all employees understand their compliance obligations and how to fulfil them appropriately.

Alongside the patient care that is undoubtedly the prime duty of healthcare workers, patient protection falls under the remit of the healthcare compliance function. This involves safeguarding their personal information, ensuring proper billing practices are in place and that all provider operations are compliant with legal requirements.

There are quite a number of regulations governing the healthcare industry which makes it a solid career path for compliance professionals. However, it is important for candidates to be able to exhibit an in-depth knowledge of the necessary agencies and acts which healthcare organisations must adhere to.

There are a number of roles within healthcare compliance; from the Compliance Officer who will face off with external parties and report back to management on all compliance issues to the Compliance Analyst who works with data to identify areas of risk, protects patient information and ultimately uses analytics to support the compliance leadership team in making the right decisions.

The Compliance Auditor is there to ensure compliance is happening on the front lines of healthcare. They will check things like patient records and billing as well as monitoring the compliance of individual employees and departments, all designed to improve internal procedures and processes. Some healthcare organisations may also employ a specialist in patient privacy and protection, who will be well versed in the requirements of regulations like HIPAA (in the US) or the Data Protection Act (in the UK) and ensure the safeguarding of all confidential patient information including medical records, authorisation forms, billing records and any other sensitive information. Measures such as system reviews, risk assessments, investigations and audits will be executed in the pursuit of information security and patient protection. Examining the types of access both from those within an organisation and its third parties will also fall under this compliance role.

Ultimately, compliance professionals working in healthcare compliance must be up to date with healthcare privacy best practices and ensure they are continually educating themselves on current regulations and the most current tactics in privacy training.

As with any area of working in compliance, candidates must exhibit an analytical mindset, strong decision-making skills, a curious mind keen for thorough investigation, attention to detail and the aptitude for strategic planning.


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