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Compliance Manager

3 months ago

Farmington, United States San Juan Regional Medical Full time

Love what you do; Love where you live

The Compliance Manager is responsible for assisting in the implementation and ongoing management of the SJRMC’s Compliance Program.

Required Behaviors : 

As you go about fulfilling this mission, your work habits and work relationships should embody SJRMC's values. These values are our culture, our identity as an organization. Sacred Trust, Personal Reverence, Thoughtful Anticipation, Team Accountability and Creative Vitality ask more of us than merely completing some list of tasks. Our values ask for a deeper level of commitment, and what is asked of us we freely give because we believe in our mission.

Required Qualifications :

Bachelor’s degree Minimum of five (5) years of experience as a legal or compliance professional; responsible for the development, implementation, and/or sustaining of an effective compliance program Minimum of three (3) years of specialized experience in hospital, physician, rehabilitation, and/or revenue cycle operations Experience in the healthcare industry dealing with federal healthcare program laws (including the Anti-Kickback Statute and False Claims Act) Experience in positively and successfully managing relationships with a diverse and energetic group of leaders (across the organization) Solid technology skills including: Excel, PowerPoint, and experience with creating data analytics An effective and thoughtful communicator; can distill and articulate the important aspects of any issue (to a wide audience of participants) An expert at quickly establishing credibility and quickly creating trusted advisor relationships with senior leadership (to navigate complex matters) Superior written and verbal communication skills and the ability to drive execution in a team environment Demonstrated management-level presentation experience Must be self-motivated, results-orientated, and a team player; with a proven ability to identify issues and manage priorities (in a fast paced environment) while striving for practical business solutions Hands on, efficient, and productive; with a bias for action and a strong sense of ownership Clinical background required Experience in auditing (clinical or financial) and investigation Certificate in Healthcare Compliance and/or Certified Professional Coder (required within 12 months of hire)

Preferred Qualifications : 

JD, CPA, MBA, or other relevant advanced degree or certification Certificate in Healthcare Compliance and/or Certified Professional Coder

Required Knowledge, Skills, and Competencies:

Demonstrated knowledge of laws and regulations applicable to the healthcare provider industry Ability to translate and articulate complex rules, regulations, and compliance issues; into terms that are understood by workforce members at all levels of the organization Ability to analyze problems, develop creative solutions to complex issues, and design, implement, and manage required polices and processes Excellent interpersonal, verbal, and written communication skills Excellent presentation skills Demonstrated success in building and maintaining collaborative work relationships (internally and externally) Ability to work with all levels of staff (particularly management and senior leadership) Skills in organizing resources and establishing priorities Adept at complex project planning/management, with the ability to effectively delegate and monitor Ability to handle confidential and sensitive information; while maintaining an exceptional level of ethical business conduct

Duties and Responsibilities:  

Assist in the ongoing development and implementation of compliance policies and procedures, compliance training, and programs Investigate and resolve compliance concerns in a timely, effective, and professional manner Respond to questions or concerns from staff, contractors, and vendors (as needed) Provide input and representation on: key compliance initiatives, meetings, and committees; as well as participate in critical risk assessments, ongoing corrective actions, and progress status updates from risk assessment(s) Stay abreast of industry and compliance trends; recommend and implement changes to internal processes (as needed) Serve as an additional point of contact for SJRMC hospital and affiliates (as a subject matter expert and resource) All SJRMC employees are responsible for implementing SJRMC’s Service Standards into their activities:

Safety, Courtesy, Effectiveness, and Stewardship

Facilitates compliance with all federal, state, legal, and regulatory requirements across the organization; as it relates to the OIG, CPGs, and federal sentencing guidelines Assists in development, implementation, and revision of policies and procedures; to assist in program improvement and comply with applicable regulatory and internal/organizational requirements Develops, coordinates, and delivers compliance-related training; to workforce members and physicians (employed and locums) Implements and manages applicable elements of SJRMC’s compliance and audit work plan; including a focus on: auditing, monitoring, identifying, and mitigating of high-risk areas Identify and assess risk associated with medical necessity based upon: CMS payment guidelines, NCDs, LCDs, OIG work plan, internal claims data analysis and trends, and reported compliance concerns Conduct medical necessity and coding reviews and audits (as part of our auditing and monitoring program) Conduct and assist in complex compliance investigations (as directed) Participates in the planning and performance of the risk assessment process; and follow-up corrective actions/work plans Reviews current and proposed programs, services, initiatives and partnerships; to identify and mitigate compliance risks and opportunities Collaborates with other functional areas to modify processes; to address compliance risks and opportunities Responds to, monitors, tracks, and reports on compliance-related activities Functions as a resource to ensure that compliance matters are appropriately evaluated, investigated, and resolved Effectively interacts and communicates with all SJRMC workforce members, physicians, contractors, patients, families, and vendors Supports Compliance & Privacy Officer with compliance special projects, program oversight, and ongoing compliance related activities Additional duties and projects as assigned

Additional Compliance Analyst/Auditor Duties and Responsibilities:  

Serves as a regulatory clinical specialist (within the Office of Compliance and Privacy at SJRMC) to help manage inquiries on a variety of compliance topics; by gathering additional details on the questions/issues and conducting relevant research Assists with the ongoing progression and maintenance of SJRMC’s compliance program efforts; including, but not limited to: policy and procedure development, risk assessment, auditing and monitoring, training and education initiatives, and compliance programmatic developments and enhancements Coordinate, monitor, and audit documentation and coding of inpatient and/or outpatient services (in all applicable health care settings). Audits will focus on correct assignment of codes (CPT, HCPCS, ICD, etc.), review for medical necessity, and clinician documentation; to ensure that SJRMC is compliant with all regulatory guidelines and internal controls. Analyze audit results and identify: patterns, trends, or variations in coding and documentation practices; and make recommendations for improvement Review and audit: coding, billing, and documentation for compliance; based on federal regulatory requirements, e.g. the Centers for Medicare and Medicaid Services (CMS) and current documentation/coding guidelines; as well as ensure compliance with departmental/internal policies and other applicable laws and regulations Prepare audit reports for all findings/observations and provide appropriate recommendations Partner with business units to develop quality improvement and corrective action plans (based on audit findings and recommendations) Perform trend analyses to identify and analyze, clinical and compliance patterns/variations (in coding practices) Assist with investigative reports of compliance violations Maintains current knowledge of federal and state regulations and guidelines (CMS, OIG, etc.); keeping abreast of current changes that may affect health care systems

San Juan Regional Medical Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leave of absence, compensation and training.