Program Manager, Compliance Analytics

JOB DESCRIPTION

Description

Position Summary

This role is directly responsible for the management and execution of multiple data science and data analytics projects in support of compliance and ethics initiatives.

Projects range in scale and includes medium and large-scale projects and project variety ranges from internally generated queries to external (third party and governmental) inquiries.

Essential Functions

• Data Analytics Responsibilities
• Leads multiple analytics projects with complex objectives / activities, diverse sets of stakeholders, and shared resources.

Specific responsibilities include :

o Requirements intake & project scoping

o Prioritization & shared resource coordination

o Change management

o Project monitoring

o Project and Progress reporting (both oral and written formats)

o Success measurement

• Organizing, combining, and managing large and varied data sets for analysis to support compliance functions, including, but not limited to auditing, monitoring, and risk isolation, and clearly communicating data findings to departmental and operational leadership.
• Develops, assists in, or directs, the gathering of needed data and analysis of the required data components for complex compliance investigations and work with operational leaders and assigned Compliance team members to determine the appropriate handling of such issues.
• Management of key internal and external reporting process and procedures to ensure timely and accurate reporting in the most automated and efficient way possible.
• Maintains updated knowledge of and uses different project management methodologies, tools, and approaches as appropriate.
• Works with the Director of Provider Compliance ("DPC") to develop and manage a consistent approach to analytic project intake and implementation across several distinct, but interrelated project areas.

Assists in identifying potential areas of overlap in projects and ensuring effective use of resources.

• Auditing & Monitoring Responsibilities
• Develops and manages the prospective and retrospective compliance documentation audits program.
• Designs tools and methodologies for conducting audits. Tracks and trend result of audits. Track and analyze physician coding patterns and documentation.
• Prepares and presents reports on audit results, and maintains adequate documentation related to such and maintains integrity of the documentation whether in paper or electronic format.
• Prepare written reports summarizing compliance audits or monitoring activities, for review, and approval.
• Develop, prepare and present reports related to compliance trends and metrics.
• Participate in the development and implementation of the annual compliance risk assessment and work plan as it relates to coding, billing, documentation initiatives.
• Reviews the implementation of corrective action plans. Identifies trends in billing, coding and documentation errors and recommends corrective action plans.

Monitors implementation and effectiveness of corrective action plans. Development of automated monitoring tools to provide ongoing analysis of coding distributions and changes and red flag triggers.

• General Responsibilities
• Contributes to special projects related to the UH Compliance & Ethics Program at the direction of and in partnership with the Chief Compliance Officer (CCO) and the Director of Provider Compliance.
• Assists Compliance Partners and Billing, Coding and Documentation area in implementing, maintaining, and continuously improving UH’s compliance program.
• Initiates and maintains positive relationships with key operational and clinical partners and co-workers.
• Stays current with relevant federal and state compliance related laws and regulations and modify the compliance program accordingly to remain compliant, as well as consistent with industry best practices.

Additional Responsibilities

Displays commitment to the mission of the hospital and its values while maintaining high standards of integrity.

Required For All Jobs

• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

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QUALIFICATIONS

Qualifications

Education

• Bachelor’s Degree Preferably in Business, IT, healthcare or related field required
• Master’s Degree JD, LLM, MBA or equivalent relevant knowledge and experience preferred

Work Experience

• 5+ years Compliance program or relevant legal experience required
• 3+ years Experience in hospitals, health systems or healthcare delivery industries preferred
• 2+ years Experience in managing medium and large-scale projects required

Knowledge, Skills, & Abilities

• Must have strong attention to detail and be an effective communicator required
• Contribute as a team player eager to jump in where needed and collaborate with others to support the goals of the Compliance Department and the needs of patients required
• Must have a strong data analytics background with Advanced Excel capabilities and MS-Access data base management; prefer experience with Tableau and Power BI report writing skills required
• Proficient experience in analyzing and / or validating complex data sets from multiple sources using Excel, Power BI, SQL or other software highly desirable required
• Must have demonstrated project management skills required

Licenses and Certifications

• Certification in Healthcare Compliance (CHC) or ability to obtain certification required
• Certified Project Management Professional (PMP-PMI) Willingness to begin work toward completion of project management certification required

LOCATION

University Hospitals is a national leader in healthcare that takes pride in calling North-East, Ohio home. With more than 150 locations throughout Cleveland and the surrounding metropolitan areas, UH provides unique opportunities to deliver world-class care in the communities where our employees live, work, and play.