System Director of Compliance

3 weeks ago

Bozeman, United States Bozeman Health Full time

Position Summary:

The Bozeman Health Board of Directors has designated the System Director of Compliance & Privacy to serve as its Compliance Officer. This position plays a critical role in ensuring that the organization operates in full compliance with health care laws and regulations. The Compliance Officer has direct access to Bozeman Health's Board of Directors and the Chief Executive Officer, while reporting to the Chief Legal Counsel. This role assumes the managerial and administrative tasks involved in establishing, monitoring and updating the Compliance Plan as well as the Compliance Department's policies, budget, and objectives. The Compliance Officer's responsibilities include: (a) strategizing, setting goals, and ensuring follow through; (b) problem solving, performing scheduled and focused audits with accuracy and thoroughness; (c) summarizing and reporting audit findings to appropriate leaders and committees; and (d) assisting with collection of data used in compliance efforts. The Compliance Officer also manages compliance and privacy concerns and serves as the organization's HIPAA Privacy Officer.

Minimum Qualifications:

+ Master's degree in healthcare related field or compliance certification; other combinations of education and experience may be considered

+ Five (5) years of experience in health care compliance

+ Regulatory knowledge required (e.g. CMS, OIG, FDA, Medicaid, Licensing, etc.)

Essential Job Functions:

+ Establishes, monitors, and updates the Bozeman Health Compliance Plan.

+ Maintains compliance hotline and conducts investigations in response to concerns identified or reported to the department.

+ Develops Annual Audit Plan to determine accuracy and validity of coding and billing submitted to Medicare, Medicaid, other federal and state health programs and other payers, and to detect any instances of potential misconduct by Bozeman Health as quickly as possible.

+ Maintains current knowledge of State and Federal regulations related to Medicare conditions of participation and Medicare and Medicaid billing and reimbursement regulations, regulatory knowledge, and HIPAA privacy rules.

+ Establishes and oversees the denial management and appeal program to prevent and mitigate avoidable denials.

+ Serves as the primary leader responsible for supporting the needs of the Compliance Committee of the Board of Directors.

+ Establishes and oversees the response to external audits from government and commercial payors to prevent and mitigate unfavorable findings.

+ Works with the impacted departments to develop corrective action plans based on internal audits, denials, and external audit findings to strengthen and improve compliance with the applicable policies, rules, and regulations.

+ Conducts Compliance Program training and partners with department leaders to coordinate, facilitate and provide specific coding and billing training as applicable.

+ Serves as a liaison between governmental agencies by assisting with investigations and/or voluntary refunds.

+ Directs broad operations and supervises staff, to ensure the provision of comprehensive departmental services.

+ Continuously assesses, measures and improves departmental performance.

+ Demonstrates responsible management of all departmental resources.

+ Demonstrates technical and managerial competency, and ensures staff professional needs are met.

+ Leads, teaches, inspires, and demonstrates health system behavioral standards.

Knowledge, Skills and Abilities:

+ Strong leadership managerial skills; ability to plan, delegate, monitor and improve work performance

+ Demonstrates sound judgment, patience, and maintains a professional demeanor at all times

+ Ability to work in a busy and stressful environment

+ Strong interpersonal, verbal and written communication skills

+ Creativity, problem analysis and decision making

+ Exercises tact, discretion, sensitivity and maintains confidentiality

+ Detail oriented, organizational skills and the ability to prioritize

+ Standard office equipment and computer applications; MS Office, EMR, internet applications etc.

+ Ability to work varied shifts

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by the personnel so classified.

77211025 Legal Services

Working at Bozeman Health is more than just a job--it's a commitment to caring for the communities of Southwest Montana by being their partner in health and wellness, compassionately delivering the best care for each person, every time. In every role, our employees are inspired by their ability to care for our community and our Culture of Excellence guides each employee to be a high performer, engage in transparent and timely communication, demonstrate dynamic learning and teaching, excel through change, express gratitude and experience joy.

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