Mgr, Compliance

This position assists the VP and Compliance Director of the Office of Business Integrity to direct and oversee the Phoenix Children's Hospital (“PCH”) Business Integrity Program. The Manager executes and leads the compliance program as approved and directed by the Chief Compliance Officer and Chief Privacy Officer, PCH Board of Directors and Senior Vice President, General Counsel by ensuring the development, implementation, and ongoing monitoring of the Compliance Program with a particular emphasis on AHCCCS billing compliance and compliance related education for PCH. Critical to the success of this role, the Compliance and Privacy Manager is responsible for independently assessing a variety of complex compliance risk-areas within PCH to develop the Compliance Department’s work plan. Additionally, this position is responsible for independently performing and conducting scheduled audits required by the audit plan, unplanned investigations, and providing compliance guidance to PCH staff.

**Position Duties**:

- Monitors the performance of the compliance and revenue integrity programs and related activities on a continuing basis, taking appropriate steps to improve its effectiveness. Prepares regular reports, as requested by the Senior Vice President, General Counsel, and Board of Directors, detailing compliance initiatives, accomplishments, trends, statistical data, etc. Recommends improvements/changes in the overall compliance program.
- Oversees compliance strategic planning and risk assessment activities, including the analysis and interpretation of the OIG Work plan, development of a system-wide annual compliance work plan and the annual audit work plan, and assistance to the operating units in developing departmental work plans.
- Develops, oversees, and maintains auditing and monitoring program of system-wide high-risk areas in compliance related and billing processes. Researches and develops system-wide benchmarks and assures the communication of review findings and alignment of best practices, as relevant, throughout the system. Develops corrective action plans to ensure resolution of risk areas.
- Collaborates with other departments, including, but not limited to, Human Resources, Quality, Research, Information Systems, and others, for system-wide integration of compliance programs.
- Develops audit work plans and conducts or supervises both planned and special audits of privacy related matters, patient medical records and bills to determine whether charges being billed are adequately supported by documentation in the record and that documented services are being billed and reported, including identification of potential system-wide areas of compliance vulnerability and risk, and development of corrective action plans.
- Reviews threshold communications from federal, state, or local agencies or from private payors regarding the payment process or the conduct of business, in collaboration and as applicable with the PCH Legal Department. Assists the operating units in responding to such inquires and investigations.
- Effectively directs outside vendors in completing audits assigned and approved with the Audit Plan.
- Prepares and assists conducting education for any applicable areas for which Compliance education efforts have been identified. Ensures all confidential and proprietary information and activities are handled discretely and information is safeguarded.
- Performs miscellaneous job related duties as requested.

**Phoenix Children's Mission, Vision, & Values**:
**Mission**
To advance hope, healing and the best healthcare for children and their families

**Vision**
Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families

**Values**
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable