POSITION TITLE: Director of Ethics & Compliance / Contracts Management & Risk Management
REPORTS TO: Chief Financial Officer dotted line to Hospital CEO
Lead, oversee, develop, implement and maintain compliance program, including but not limited to providing education and training: responding to compliance questions, inquiries and concerns; auditing and monitoring activities; and review and updating of compliance and compliance related policy and procedures in assigned hospitals. Facilitate and be an advocate for compliant behavior consistent with the mission, vision and values of RegionalCare and the hospital.
- Assist in directing the Corporate Compliance department operations, including but not limited to compliance education and training, hotline services, conflicts of interests, research compliance, policies and procedures under the guidance of the Chief Compliance Officer;
- As Facility Privacy Officer, oversee all ongoing activities related to the development, implementation, maintenance of and adherence to the organization’s policies/procedures covering the privacy of and access to, patient health information in compliance with federal and state laws;
- Develops, guides, supports and maintains the compliance program and conducts regular reviews of the program’s functionality and proposes modifications and multifaceted education as needed to ensure that all employees understand and comply with relevant federal and state laws, guidance and standards. Periodically work with Chief Ethics and Compliance Officer to revises compliance program based on regulatory, legal and/or changes in the standards and practices.
- Prepares reports on compliance matters for presentation to the Executive Team, Medical Staff, the Hospital CEO and the Hospital Governing Authorities.
- Advises hospital on the implementation and effectiveness of the compliance program and when necessary, identifies the need for enhanced compliance vigilance at hospital.
- Develops, implements, and monitors enhanced procedures.
- Monitors the implementation and communication of the compliance program to employees through effective training programs, newsletters, memos and other appropriate means to support the company’s culture of compliance.
- Serves as an internal investigator for compliance issues conducting investigations of alleged violations of the compliance program and provides guidance on how to handle violations promptly, properly and consistently.
- Identifies areas of non-compliance and potential non-compliance and directs implementation of corrective actions to remediate the findings of non-compliance and potential non-compliance via routine audits of medical records documentation, billing records, access audits for privacy compliance and review and analysis of anonymous reports.
- Serves as liaison with appropriate management and employees to evaluate and coordinate prompt remediation of report or observed incidences of patient care that are or potentially inconsistent with company compliance policies.
- Oversees periodic audits by internal and external parties and develops any resulting corrective action plan as directed by corporate compliance.
- Coordinates with corporate compliance and legal counsel, as necessary, to investigate and report any self-disclosed violations of federal or state law.
- Adheres to record keeping system to document the ongoing operation of the compliance program.
- Promotes awareness of practices and industry standards and proactively identifies emerging regulatory issues and compliance program trends.
- Communicates with vendors, independent contractors and agents, and monitors performance to ensure awareness of and compliance with compliance program.
- Coordinates with Human Resources and appropriate employees to ensure that the List of Excluded Individuals/Entities is checked with respect to all current and prospective employees, vendors, independent contractors and agents.
- Leads Ethics & Compliance Committee
- Oversees all audits
- Maintains regular and predictable attendance.
- Performs other essential duties as assigned.
- Strong preference for eight to ten years of experience in healthcare compliance matters, preferably for a large, multi-faceted healthcare organization.
- Bachelor’s Degree or a minimum of 5 years industry related experience in health care compliance or related field. Masters preferred.
- Strong working knowledge of current federal and state regulations and healthcare laws, relevant regulatory guidance, auditing procedures, HIPAA, coding and risk management.
- Demonstrated knowledge of Medicare and Medicaid reimbursement and fraud and abuse laws.
- Ability to prepare clear and concise reports, correspondence and other written materials on findings and actions taken.
- Ability to develop and conduct effective compliance training programs.
- Strong business acumen, understanding of key business drivers and how the business works.
- Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.
- Excellent interpersonal skills and the ability to interact effectively and professionally with individuals at all levels, both internal and external.
- Experience with Compliance360; HealthStream; EthicsPoint are a strong plus.
- Excellent organizational skills with attention to detail and the ability to plan, implement and manage multiple projects simultaneously within inflexible time frames, as well as the ability to deal with priority changes.
- Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the organization.
- English sufficient to provide and receive instructions/directions.
- Valid and current driver’s license
- REQUIRED: CHC certification or equivalent (or must be eligible to take certification exam within 90 days of employment
- PREFERRED: Master’s Degree, J.D., experience in hospital or physician practice compliance
Normal hours are 8 a.m. – 5 p.m., Monday-Friday. However, schedules may vary in accordance with business necessity. Normal office working conditions. Available for weekend and night support for emergencies.
This town is located about 2 hours from Atlanta yet has everything you could ever want! Enjoy the Riverwalk that runs through town or the many museums, performing arts center, historical centers, opera house, or the numerous parks in the restored downtown district. They also have a military base nearby as well as a university in town. This is the 3rd largest city in GA. From Broadway shows to the State Theatre of Georgia – this city offers an array of venues with world-class entertainment. From the history of the foot soldier, the Civil War and prisoners of war – the city is home to nationally acclaimed museums. Visitors stroll back to genteel times in the Historic District where brick streets, ancient oaks and century-old homes are the order of the day. And they even has world class whitewater rafting! The natural flow from the river will create the longest urban whitewater course in the world. This incredible release will also restore the natural habitat of many aquatic species, including the shoal bass and fresh water mussel, making it a fisherman’s paradise. Come experience all the area has to offer!
Competitive Salary Range!