Vice President Compliance

Vice President Compliance Guidance and Risk Assessment

Job Summary

Under the direction of the Chief Compliance Officer, the Vice President Compliance and Risk Assessment is a member of the Office of Ethics and Compliance (OEC) leadership team. The Vice President Compliance Guidance and Risk Assessment will help create and execute the strategic vision of the OEC and is responsible for managing, directing and coordinating the work of the Regional Compliance Officers in facilitating compliance with applicable laws, regulations, and organization policies within assigned geographical regions and service lines. The Vice President Compliance Guidance and Risk Assessment is responsible for the oversight of all regional and service line compliance related activities, assisting the Regional Compliance Officers (RCOs) with their leadership and guidance as they work collaboratively with the Entity Compliance Officers (ECOs) and physician liaisons throughout the organization to ensure consistency in behaviors and processes across the organization in connection with the UPMC Code of Conduct, UPMC No Retaliation policy and UPMCs Conflicts of Interest policy and other policies for which of OEC is responsible. In addition, the Vice President Compliance Guidance and Risk Assessment will be responsible for identifying and assessing various internal and external risks to the organization. The Vice President Compliance Guidance and Risk Assessment will assist the CCO with driving change to ensure compliance with regulatory and policy obligations, educating leaders and promoting an ethical and compliant culture across the UPMC health system and is also responsible for building relationships with the other members of the OEC leadership team, the RCOs, ECOsphysician liaisons, presidents, senior leaders, and the board of directors. This is a highly visible position that interacts with all UPMC business units at all levels of the organization.

Responsibilities

Acts as the lead compliance representative in coordinating the recommendations/guidance regarding potential and identified regulatory and compliance risks, policy, training, investigation, and communication strategies to leaders, RCOs, ECOs, and physician liaisons throughout UPMC and within assigned region. Directs the Regional Compliance Officers and service line compliance officers in the coordination and standardization of compliance approach/response across UPMC.

Serves as the connection to the OEC for the RCOs and their assigned leaders, ECOs, and physician liaisons by providing initial orientation and ongoing mentorship for all regional compliance.

Assists the Chief Compliance Officer with the development, scoping, and implementation of the annual Compliance Workplans and reviewing and reporting on regional risk areas.

Assists with the creation and support of Compliance Auditing and Monitoring workplans and requests within the region, as well as implementing recommendations for corrections, tracking corrective action plans, and identifying needs for Compliance Officer Action Steps within the region.

Creates and manages effective action plans in response to audit discoveries, compliance trends, and compliance violations.

Maintains a working knowledge of the various regional healthcare laws, regulations, and industry guidance that impact the corporate compliance program.

Provides strategic and operational guidance/advice regarding healthcare regulatory changes and ensures that regional management has implemented the proper process changes.

Facilitates and assists with responses to Compliance AskUs inquiries.

Manages the Compliance HelpLine . Promotes use of HelpLine within the region and identifies when an entity reported concern qualifies as a matter to be addressed by the OEC. Identifies reporting trends, high risk events. Supports low-level investigations upon ECO request; facilitates medium and high-level Helpline investigations.

Leads ECO and physician liaison training and development with the assistance of the RCOs and other members of the OEC. Develops, coordinates, and participates in topic specific education and training programs that focus on the elements of an effective compliance program as required by the entities.

In collaboration with other members of the OEC, leads efforts to develop and promote compliance related awareness and communication topics, including awareness tools, newsletters, current events, compliance week, etc., for targeted audiences such as new hires, board members, volunteers, and physicians to be used by the ECOs and compliance liaisons.

Provides board of director education as requested.

Aids in identifying educational opportunities for the Compliance Officer Forum, liaison group and management meetings as well as prepares and presents topics routinely.

Coordinates with the OEC for all external agency complaint investigations, reviews all corrective action plans and addresses any plan issues.

Supports OEC in coordinating and/or conducting research and guidance as needed.

Assists the OEC with the annual disclosure communication for Conflict-of-Interest reporting, supports the dispute/correction process for the Physician Payment Sunshine Act, as well as resolves any regional issues regarding the Sanctions and Exclusions process or Conflicts of Interest, as needed.

Functions as a resource to answer and address questions from all entities within their region to help build a forward-thinking compliance approach across the entire organization.

Participates and leads regional or system-wide committees/workgroups as requested as a representative of OE&C.

*Requires occasional travel to regional facilities including some overnight travel.

*Performs in accordance with system-wide competencies/behaviors.

*Performs other duties as assigned.

Educational and Knowledge Requirements

• Bachelor's degree in business, law, nursing, healthcare administration or related field.

• Master's degree or compliance related certification required

• A minimum of 10 years of experience in compliance-related areas such as Regulatory Review, Reimbursement, Billing, Medical Records, Clinical Laboratory, or Physician Practice Management.

• A minimum of 5 years of previous experience in related leadership roles required.

• Healthcare experience on federal and state provider requirements is required

• Computer skills and well-developed analytical, problem-solving skills

Licenses and Certifications Notes

Juris Doctorate (JD), Certification in Healthcare Compliance (CHC), Master's Degree or other related regulatory, coding, or clinical Licensure/Certification required