Compliance Program Manager

Job Summary:

Under the direct supervision of the Chief Compliance Officer or Manager, Compliance, this position contributes to the RSFH mission and vision by managing compliance program initiatives to identify and mitigate emerging compliance risks to the organization. This position assists the Chief Compliance Officer or Manager, Compliance by tracking, trending, and reporting of analytics to help identify risks and recommending proactive monitoring initiatives and is responsible to manage the performance of assigned work plan audits, management requests, due diligence reviews and responses to governmental audits and inquiries.

The CPM assists the CCO or MC with 1) conducting an annual risk assessmentwhich is used as the basis for the annual compliance plan; 2) resolving allegations of non-compliance; 3) developing and administering on-going compliance education; 3) conducting and/or overseeing the auditing and monitoring of activities which pose compliance risks; 4) maintaining a compliance database for all activities conducted by the department; 5) researching and responding to compliance related questions; 6) staying abreast of and communicates changes to applicable regulations; 7) developing and overseeing the annual functional compliance officer and their respective workplans; 8) facilitating and responds to any third-party investigations; and 9) providing reports to the necessary councils, committees, and other forms of leadership.

Minimum Qualifications:

Education: Bachelor�s degree required but masters or law degree preferred.In lieu of degree, 10 years of relevant experience is required. Professional experience in auditing, medical review, billing and coding compliance, and other various healthcare positions can substitute for higher degrees.

Experience: 5 years of experience within healthcare operations and/or healthcare auditing either from a consulting perspective or as an associate or manager (required).

Licensure/Certification: Coding or compliance credential required. Such as: Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC), Certificate of Healthcare Compliance (CHC), EPIC Electronic Medical Records System (preferred)

Knowledge/Skills: Effective communication (written and oral) ability, and analytical skills required.Must practice critical thinking skills, demonstrate good judgment and discretion in dealing with patients, visitors, physicians and staff. Maintains a high degree of credibility, independence, integrity, confidentiality and trust.Strong communication and leadership skills are essential.Demonstrates sound business judgment and is supportive of the RSFH mission and objectives.Commands the respect of the senior management, board level committees and other members of the compliance team.Strives to develop partnerships, teamwork and good working relationships.Understands the complexities of a large organization. Involves others appropriately in consultations and decisions.Have strong analytical skills and an understanding of operational processes and related systems and technology concepts.Able to operate successfully in a constantly changing, fast-paced environment.Demonstrates initiative, self-motivation, practical learning skills, and enthusiasm, and an ability to complete tasks in a timely and accurate manner. Specific experience with regulatory issues is desirable.Consistent record of designing and implementing efficient and effective policies, procedures and monitoring systems.

Contacts: Reports to the Chief Compliance Officer or Manager, Compliance directly but may also report directly to the Vice President of Legal and potentially to the CEO of RSFH regarding any serious matters that are not in conformity with the Compliance Plan.Regular reports regarding activities in the Compliance Program are made to the CEO and the Board (through the Audit and Compliance Committee).May report directly to the Board of Directors if the CEO is the source of or not responding to violations of the Compliance Plan. Frequent interaction with staff throughout the system as well as with management, Boards, outside counsel, vendors, consultants, patients and families is part of the position.This interaction may often deal with unhappy, angry, or hostile persons.