Area Compliance Program Director

POSITION SUMMARY

This position plans, designs, implements and maintains a compliance program including related policies, procedures and processes with a principal focus on an assigned (a) hospital or other health care facility, (b) provider group, (c) ancillary service or business area, or (d) business support area (collectively referred to herein as the Assigned Area ).

Serves as a role model for ethical management behavior and promotes an awareness and understanding of high ethical standards consistent with the organizations values and federal and state legal requirements.

Based on the Assigned Area, serves as the compliance program resource and liaison, including HIPAA and privacy compliance.

CORE FUNCTIONS

1. Directs, implements, maintains, and enforces Assigned Area compliance programs, including related policies, procedures and processes on a daily basis, in conjunction with organization-wide compliance efforts, as well as federal, state and local regulations, such as Medicare, Medicaid, and HIPAA.

Ensures all programs and related efforts are consistent with the organizations compliance philosophy and strategies established by the top compliance executive.

2. Contributes to the system-wide compliance audit function by directing related activities within the Assigned Area. This includes directing investigations and monitoring compliance activities in accordance with compliance program standards, policies and procedures.

Reviews and ensures compliance with federal and state regulations imposed by government agencies and others. Advises on audit controls for internal processes ensuring appropriate measures are in place for accurate, complete and compliant programs throughout the Assigned Area.

Proactively identifies areas throughout the Assigned Area where there may be substantial risk of unlawful or unethical conduct and responds accordingly in a timely fashion, including encouraging local reporting of potential issues.

3. Contributes to development and implementation of system-wide compliance training programs as applicable to the Assigned Area.

This includes participating in the preparation of presentation materials designed specifically to communicate and promote the understanding of compliance and privacy issues, laws, and consequences for noncompliance, as well as delivering the training programs throughout the Assigned Area.

4. Oversees the thorough documentation of all compliance related activities for the Assigned Area to ensure compliance with federally mandated reporting requirements.

Ensures reporting requirements are maintained in a timely and accurate fashion for the Assigned Area, including the resolution of each case / issue identified and closed.

Reports on matters of business ethics, legal compliance and operations of the program.

5. Reviews highly complex and sensitive questions, concerns and complaints relative to compliance matters, and provides leadership and support to the Assigned Area as appropriate.

Ensures that reasonable steps are taken to respond timely and appropriately to ethical or legal compliance violations, to prevent further violations and to advise regarding potential discipline of violators appropriately and consistently.

Oversees investigations of ethical and legal violations to ensure consistency in the enforcement of the program.

6. Supports, through leadership and oversight, the Assigned Area’s compliance management staff throughout their facilities or areas, including providing ongoing support in the development of compliance goals and objectives.

Conducts Assigned Area rounding on an ongoing basis and communicates trends and areas for improvement for the Assigned Area.

This position also acts as a compliance resource to the Assigned Area as needed or requested to address and resolve compliance related issues.

Chairs compliance committee meetings at appropriate levels based on the need and direction of the Assigned Area.

7. Maintains a current awareness of compliance-related laws and regulations, keeping abreast of current changes that may affect the Assigned Area as well as overall health care systems through personal initiative, seminars, training programs and peer contact.

8. This position may supervise professional staff. This includes directing personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training and personnel evaluations.

9. Internal customers include senior management, physicians and all staff at assigned facility or facilities. External customers include state and federal agencies.

MINIMUM QUALIFICATIONS

Must possess a strong knowledge of business and / or healthcare compliance as normally obtained through the completion of a bachelors degree in business administration, accounting / finance, or health care related field.

Requires knowledge of laws and regulations pertaining to health care, regulatory compliance, hospital and / or physician billing and information systems, Medicare / Medicaid and financial reimbursement systems, and HIPAA Privacy and Security issues.

Must possess strong planning skills and problem solving skills. Must possess strong oral and written communication skills to effectively interact with senior management team, physicians and federal and state governing bodies.

Must also possess highly effective negotiating skills to communicate and interact with senior management team and physicians.

PREFERRED QUALIFICATIONS

Masters Degree preferred; previous health care or academic compliance experience preferred; minimum three years of healthcare or academic management experience preferred.

Additional related education and / or experience preferred.

EOE / Female / Minority / Disability / Veterans

Our organization supports a drug-free work environment.

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