AVP Ent Compliance

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The Enterprise Associate Vice President (AVP) of Compliance is responsible for planning and directing the implementation of the WV University Health System (WVUHS) strategy as it pertains to Compliance (and possibly Internal Audit) for WVUHS and its affiliated entities. Additionally, this individual will function as the site manager for all compliance related matters for WVU Hospitals, Ins. The individual will have responsibility for helping ensure that all WVUHS entities, University Health Associates (UHA), Allied Health Solutions, the ACO of WV, and other applicable system entities maintain ongoing compliance with federal and state government rules and regulations, while retaining revenue integrity for the organization overall. This includes implementing the corporate code of conduct, drafting/authoring policies, establishing procedures to prevent, detect, and correct violations of laws, rules, regulations, or contractual obligations, by employees, officers, or other agents of each department, within the organization. The AVP will oversee and coordinate staff and elements of system-wide compliance and internal audit functions for WVUHS hospitals, physician groups, and other entities to ensure overall compliance. The position will work directly with local and regional Compliance Directors to assist in completion of work plans and serve as a system wide resource on compliance and internal audit matters. The AVP of Compliance may lead due diligence efforts at the system level with guidance from the Chief Compliance Officer. In addition to the above this individual serves as the Compliance Officer for WVUH.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree in healthcare administration, business administration, or related field AND successful completion of CHC (Certified in Healthcare Compliance).

EXPERIENCE:

1. Ten (10) years of progressive Compliance leadership experience in the healthcare industry. .

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Registered Health Information Technician (RHIT) or Certified Coding Specialist- Physician (CCS-P) certification.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. In conjunction with Chief Compliance Officer develop strategic plan and direction for system-wide Compliance and Internal Audit functions. Manages a multi-disciplinary team of employees and their competency to assist the system in meeting its Compliance and Internal Audit needs.

2. In conjunction with Chief Compliance Officer develop and analyze strategic plans of the organization, including potential mergers and acquisitions to ensure that Compliance is progressive in reference to the regulations and work flows at the system and local level.

3. Develops and manages system wide compliance functions such as hotline contract, sanction and exclusion screenings, and contracts with outside auditors. Performs the system administrator functions for the hotline database and educational resource for facility directors.

4. Works with the CCO in the Development and management of the overall audit and education process WVUHS and its affiliated entities.

5. Serves as the Compliance Officer for WVUH as a member of the leadership team, the key contact for compliance issues and/or questions originating at WVUH.

6. May also be responsible for the management, oversight, and facilitation of the WVUH Board Compliance and Audit Committee.

7. Authors and implements corporate compliance policies and procedures to prevent, detect, and correct violations of laws, rules, regulations, or contractual obligations, by employees, officers, and other agents within WVUHS, ACOWV, and all other system entities to help ensure revenue integrity for the organization(s).

8. Develops, maintains, and supports the implementation of all ongoing efforts of the System Level Compliance Program (and applicable Internal Audit activities) by serving on both WVUH and WVUHS level committees, promoting compliance awareness, and supporting the compliance hotline process. These may include committees (WVUHS and/or WVUH) or task forces such as Enterprise Risk Management, Enterprise Value Analysis, Enterprise 340B Drug Program, Enterprise Charge Master, Enterprise Legal Health Record, Enterprise Policy Committee, Enterprise Transactions, Enterprise Utilization review, WVUH Drug Diversion, WVUH Device Recalls, WVUH Policy Committee, WVUH Care Management Steering Committee. Participation and involvement is committees will be determined through discussions with the CCO and other leaders within WVUH.

9. Conducts an annual risk assessment and based on the results and risk factors, develops an overall system level annual work plan for internal audit and compliance as well as specialized work plans for designated system specific entities (ACO of WV, AAS, Allied Health, UHA, etc.). Constantly evaluates work plans and makes revisions as needed as determined by the industry and/or internal needs.

10. Provides senior level support, development, and guidance to local compliance directors for WVUHS facilities and WVUH

11. Coordinates the process of auditing and monitoring associated with the compliance work plan and as applicable the internal audit work plan. Presents completed reports to the respective management team and monitors associated corrective action plans. This includes management of staff to complete audit work at other local/regional locations.

12. Responsible for ensuring that staff complete necessary elements of audit and analysis to support revenue integrity controls based on the charge capture process, physician and hospital coding principles, physician and hospital billing regulations, and reimbursement policies applied by federal and/or state regulations and contracted commercial payors. Based on the findings and results, ensure proper communication and distribution of the summary and work with each stakeholder to develop and implement corrective action including initiation of any necessary refunds and/or self-disclosures that may be required, provide input on revision of work flows in the EMR or other applications, etc.

13. Develops and coordinates initial and ongoing compliance training (code of conduct, fraud, waste and abuse, conflict of interest, etc.) and educational efforts on compliance for all levels of the organization, including the Board of Trustees, executives, managers, employees and professional staff. This may include new employee compliance training for WVUHS entities, Allied Health Solutions, and the ACO of WV.

14. Develops and maintains a routine reporting process to the Board of Directors, Compliance Committee, and senior leadership with timely and relevant information on the status of programs, internal audits, and periodic risk assessments on compliance issues.

15. Coordinates and provides assistance to the WVUHS Chief Compliance Officer in compliance matters. Upon request of WVUHS Chief Compliance Officer, shall do the following: act as coordinator with any outside counsel in regard to any compliance issues and review any contracts regarding compliance.

16. Pursues education and training opportunities to assure compliance with current laws, rules and regulations by participating in professional education activities, obtaining and maintain relevant certifications, and networking with industry peers.

17. Coordinates activities with external auditors, including financial auditors, third party auditors, and regulatory auditors (CMS, OCR, OIG, WVBMS, etc.)

18. Assists in developing and maintaining budgetary activities (both locally and at the system level) and ensuring proper staff allocations are in place to meet system needs.

19. Responsible for completion of employee evaluations, development plans, maintenance of personnel files, etc.

20. Evaluates and implements new technologies/software to facilitate and support the expanding role of compliance and internal audit at the system level. This may include audit-assist software, hotline platforms, policy/procedure management platforms, etc.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Extended periods of sitting.

2. Extended periods of computer and telephone usage.

3. Must be able to move throughout the department work areas.

4. Must have clarity of speaking and hearing.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard office environment

SKILLS AND ABILITIES:

1. Excellent organizational and time management skills.

2. Outstanding verbal and written communication skills.

3. Excellent presentation skills preferred.

4. Ability to utilize electronic medical record and billing systems.

5. Extensive knowledge of healthcare compliance, revenue cycle operations, and auditing techniques required.

6. Must be able to identify deficiencies in the control environment based on evidential data and the ability to identify any deficiencies resulting in financial loss or regulatory noncompliance.

Additional Job Description:

Scheduled Weekly Hours:
40

Shift:

Exempt/Non-Exempt:
United States of America (Exempt)

Company:
SYSTEM West Virginia University Health System

Cost Center:
508 SYSTEM Compliance

Address:
3040 University Ave

Morgantown

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.

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