PRIMARY DUTIES AND RESPONSIBILITIES

• Participate in the implementation of all SolutionHealth entities' compliance activities, programs, policies and procedures, to ensure system integrity and compliance with applicable federal and state laws and regulations.
• Works diligently to foster a culture and climate of sensitivity to compliant and ethical behavior within the organization.
• Manages annual audit work plans.
• Manages and coordinates the monitoring and auditing activities including provision of required reports committees including Senior Leadership and Board of Trustees members.
• May supervise other compliance personnel (auditors, specialists, etc.), as determined by the Chief Compliance and Privacy Officer.
• Regularly reviews the Corporate Compliance Program policies and manuals and recommends appropriate revisions and modifications.
• Assists with upholding and enforcing local System's Code of Conduct. This involves working with department directors and managers to assure that employees' performance evaluations include an adequate assessment of each employee's knowledge and compliance with the Code of Conduct.
• Assists with maintaining a confidential/anonymous reporting system, including a telephone help line, to allow reporting of suspected noncompliance or incidents of fraud and abuse, and adopting procedures to protect anonymity and protect complainants from retaliation.
• Assists with timely review of complaints, concerns or questions relative to compliance issues, and provides consultative support to all SolutionHealth entities as appropriate.
• Helps coordinates personnel issues with the human resources office when identified during compliance activities.
• Maintains a record of all reports of suspected compliance issues, or fraud and abuse.
• Helps develop mechanisms for communicating changes in applicable laws and regulations or changes in the Code of Conduct to affected individuals.
• Works with appropriate department directors and managers to develop mechanisms for preventing, detecting and remediating compliance issues.
• Assists with the development and implementation of compliance training, education and other preventative mechanisms for reducing the risk of noncompliance or fraud and abuse, to all SolutionHealth employees, Board members and medical staff. Monitors records of participation in compliance training and education programs. Responsible for ensuring that new hires receive compliance training at orientation.
• Assists with the development and implementation of monitoring, auditing and other detection mechanisms for identifying occurrences of noncompliance or fraud and abuse. Assists the hospital's financial and revenue cycle management in coordinating internal compliance review and monitoring activities. Reviews reports of all internal audits and investigates any identified areas of noncompliance revealed in those audits. Works with SolutionHealth s legal counsel to retain and oversee periodic external auditing, when appropriate. Works with Finance Department (and counsel when appropriate) to assure repayment of billing errors according to local entity policy.
• Helps coordinate Health Information Portability and Accountability Act (HIPAA) and other privacy concerns, issues or reported violations, and any required inquiries and documentation.
• Develops, maintains, and delivers privacy-related policies and training. Coordinates with system-wide resources to ensure effective privacy programs and practices.
• Provides subject matter expertise regarding privacy issues and leads privacy investigations.
• Identifies compliance and privacy related risk areas and conducts audits of such risk areas and makes recommendations based upon audit findings.

POSITION QUALIFICATIONS

• Education
  • Bachelor's degree with healthcare compliance experience is required. Juris Doctor (J.D.) from law school preferred.
• Licensure/certification
  • Healthcare Compliance Certification (CHC) or other compliance certification strongly preferred.
• Experience
  • Must possess three to five (3-5) years of work-related experience in health care law and regulatory matters.
• Knowledge
  • Knowledge of applicable federal and state laws and regulations related to compliance and privacy issues, including fraud and abuse. This includes timely and detailed analysis of guidance issued by and activities of the Office of Inspector General (OIG), Centers of Medicare and Medicaid Services (CMS), and other governmental agencies. This also includes remaining current and conversant regarding changes that may affect compliance and privacy issues pertaining to healthcare systems, through personal initiative, attendance at seminars and training programs, and professional peer contact and networking.
  • Knowledge of specific laws and regulations, and regulatory, investigative and enforcement activities applicable to health care systems.
  • Sophisticated understanding of the health care and hospital environment, as well as reimbursement systems, risk management, legal and performance improvement issues and activities pertaining to health care