Responsibilities:
Customer Relations
- Maintains effective communication with enterprise leadership and the Board of Trustees.
- Actively seeks to provide quality services that meet the needs of patients and clients as well as other customers - payers, families, referrers, and staff.
Policies
- Develops and reviews the enterprise’s policies from a compliance focus.
- Works with health system leaders to interpret regulatory and accreditation requirement and develop policies and procedures that operationalize these requirements.
Audit Plans
- Oversees annual enterprise audit plan, in consultation with hospital QA.
- Provides oversight, through appropriate delegation, to program billing audits and the professional fee billing/coding for Medicaid/Medicare and other payers.
- Creates and manages effective action plans in response to audit discoveries.
Regulatory/Accreditation Compliance Oversight
- Stays abreast of outcomes of all licensing visits and surveys.
- Oversees the Community Program’s CARF accreditation survey process and stays abreast of the hospital’s TJC accreditation survey process.
- Oversees application for deemed status and conditions of participation during the award period. Stays abreast of updated information for presentation to the core service agencies.
- Assures the preparation of Performance Improvement Plans for areas cited in surveys.
Staff Education/Training
- Responsible for establishing and coordinating proper reporting channels for compliance issues.
- Assures that all employees receive required compliance training.
- Assures communication/training so that all employees are aware of various ways that they can report concerns about compliance, including anonymous reporting.
Concern line Investigations
- Oversees the resolution of employee concerns about legal compliance.
Reporting
- Reports independently to the CEO and executive team on all compliance matters and relevant issues.
- Develops and is responsible for the annual review and revision of the enterprise Compliance Plan.
- Leads implementation and enforcement of the enterprise’s compliance program.
- Prepares quarterly and periodic reports as requested to board committees and health system leadership.
- Advises enterprise leadership on possible risks.
Other Duties
- Completes system-wide and site-specific projects as requested.
Requirements:
- Requires Bachelor's or advanced degree in law, finance, business administration, public health, or a related field and 5-7 years of relevant experience, including at least 3 years as a compliance officer. Master’s degree is preferred.
- Work requires strong interpersonal skills to direct staff, oversee or conduct investigations, assure problem resolution, represent the enterprise to a number of federal and state agencies, and report compliance to the board and executive leadership.
- Work requires a high level of analytical skills and attention to detail..
- Working with enterprise-wide plan requires attention to detail and deadlines and very frequently (51-80% of work time) produces a high level of mental/visual fatigue.