Director - Hospital Compliance - Corporate Compliance for Luminis Health
About the Job
The Director of Hospital Corporate Compliance reports to the Senior Director, Corporate Compliance and directs the day to day of I/P functions of the Corporate Compliance Program in conjunction with the Chief Compliance Officer. Designs and implements programs, policies and practices to ensure compliance with federal, state, local regulatory requirements to include HIPAA, and accreditation standards. Tracks laws and regulations that might affect the organizations policies and procedures. Prepares compliance reports to present to senior management.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- In conjunction with the Chief Compliance Officer, investigates and acts on matters related to compliance, including the flexibility to design and coordination of internal investigations (e.g., responding to reports of problems, compliance hotline calls, or suspected violations) and any resulting corrective actions with all health system incumbents;
- Researches and analyzes all sources such as statutes, recorded judicial decisions, legal articles, treaties, constitutions, and legal codes to assist Administration in decision making;
- Develops, coordinates and participates in a multifaceted educational and training program that focuses on the elements of the compliance program, and seeks to ensure that all appropriate employees and leadership are knowledgeable of, and comply with, pertinent federal and state standards;
- Works with the Institutional Review Board (IRB) to insure compliance with federal and state regulations governing clinical trials, protocols and IRBs. Works with IRB leadership to insure compliance;
- Develops, reviews and revises as necessary any and all departmental and institutional policies to insure operational effectiveness and compliance with state and federal laws and regulations;
- Maintains a working knowledge of the Health System and its corporate components, with an understanding of the corporate function and interaction of the various Health System affiliates;
- Maintains a working knowledge of federal and state regulatory compliance, including state Medicare fraud and abuse, HIPAA;
- Conducts periodic audits of the System's compliance program and compliance with applicable federal and state laws, rules and regulations;
- Working knowledge in the areas of patient access, billing, accounts receivable and cash management requirements, health insurance, and business office operations;
- Champions revenue cycle improvements throughout the organization including working with appropriate individuals including medical records, billing, denial management, etc., to aid in the resolution of identified revenue cycle issues;
- Meaningfully participates in the development and implementation of the annual Compliance Work Plan for the Health System; and
- Performs special projects and other duties as assigned.
The minimum level of education and experience for this position includes:
- Master’s degree in Health Care Planning, Business Administration, Public Administration or related field required.
- 5+ years of management/supervisory experience, preferably in a hospital setting.
- Experience with conducting compliance investigations, preferably in outpatient (ambulatory) setting.
- Strong project management and organizational skills.
- Healthcare Compliance Certification from the Compliance Certification Board (“CCB”) and/or a Graduate Certificate in Health Care Compliance within two (2) months of appointment and maintain such certification throughout employment.
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands –
Light work. Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls required exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.