Manager Corporate Ethics & Compliance - Provider Compliance

JOB DESCRIPTION

JOB SUMMARY

The Manager of Provider Compliance oversees the Provider Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues / concerns within the provider organizations.

The position reports to the Director of Billing Regulation and Coding Compliance. Functions and ensures that leadership, management, providers, and employees comply and follow the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the company’s Code of Conduct.

ESSENTIAL FUNCTIONS OF THE ROLE

Collaborates with other departments (, Risk Management, Internal Audit, Employee Services, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution.

Consults with Corporate Counsel as needed to resolve difficult legal compliance issues.

• Evaluates, recommends and initiates the investigation of compliance issues as appropriate.
• Monitors, and as necessary coordinates compliance activities of other departments / facilities / practices to remain abreast of the status of all physician compliance activities and to identify trends.
• Actively participates as a compliance resource and consultant for physicians, advance practice providers, practice administrators, and other physician practice staff.

Manages work plan projects and initiatives. Works to ensure timely resolution of compliance issues and facilitates communication of compliance-related matters.

• Maintains working knowledge of Federal, State, private payer, and other applicable legal and regulatory requirements for the physician compliance department.
• Develops and implements the annual compliance initiatives and activities and associated work plan, ensuring that compliance issues and areas of risk are identified and addressed.
• Manages curriculum development and strategic delivery used to train and educate physicians and other clinical staff in compliance.

Identifies appropriate resource materials used to enable physicians and staff to comply with compliance requirements.

• Assists in developing and maintaining Provider compliance policies and procedures. Periodically reviews, updates, and adds policies and procedures as needed with the approval of the HTPN Compliance Committee and the HTPN Board of Directors or the Scott & White Board of Directors, as applicable.
• Actively supports the HTPN Compliance Committee and any other committees, as applicable. Prepare for each compliance committee meeting, develop agenda, disseminate materials, conduct meeting in support of the committee chair, and ensure appropriate follow-up on issues presented at compliance committee meetings.
• Assist the BSWH Office of Corporate Ethics and Compliance in identifying, evaluating and resolving potential conflict of interests.

Identifies potential areas of compliance vulnerability and risk; develops / implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations.

• Provides reports on a regular basis, and as directed or requested, to keep HTPN and the BSWQA senior management informed of the operation and progress of compliance efforts.
• Special projects as needed.

KEY SUCCESS FACTORS

• A minimum of 5 years’ experience in a healthcare organization, preferably physician practice platform experience; and to include demonstrated leadership.
• Familiarity with operational, financial, quality assurance, OSHA, CLIA and human resource procedures and regulations is a must.
• Candidate should be self-motivated, confident and assertive, able to garner the respect of others and influence change.
• Excellent Communication skills, both written and verbal, and an ability to interact with all levels of management, providers, and staff throughout the organization.
• Highly organized and attentive to detail.
• Highest standards of personal and professional ethics and integrity.
• Certified in Healthcare Compliance (CHC).
• Proficient in the use of Microsoft Office programs, including Word, Excel, PowerPoint, and Outlook.
• Epic, Smplr, I-Sight, COI-Smart experience preferred.

BENEFITS

• Our competitive benefits package includes the following
• Immediate eligibility for health and welfare benefits
• 401(k) savings plan with dollar-for-dollar match up to 5%
• Tuition Reimbursement
• PTO accrual beginning Day 1
• Note : Benefits may vary based upon position type and / or level

QUALIFICATIONS

• EDUCATION - Bachelor's
• EXPERIENCE - 5 Years of Experience
30+ days ago