Job Description

Assists with the implementation, continued operation, and maintenance of the Corporate Integrity Program. Oversees the organization’s compliance plan, Code of Conduct, the Compliance Hotline and other reporting mechanisms. Manages the conflict-of-interest processes and system, key policies and procedures, compliance education, and investigations.

Essential Functions:

• Assists with the maintenance, monitoring, and enforcement of the Standards of Conduct and Corporate Integrity Program. Assists ACO and Senior Compliance Associate(s) on compliance program effectiveness initiatives.
• Assists with the development, implementation, and communication of policies and procedures, changes to policy, regulations, and guidelines, and participates in development and presentation of educational materials for key topics.
• Assists with maintaining channels for reporting compliance concerns, conducting investigations, and monitoring for follow up and recommendations. Analyzes compliance concerns, questions, complaints from internal customers. Assists ACO and Senior Compliance Associate with resolution of more complex inquiries.
• Serves on key committees throughout organization in need of compliance oversight, provides guidance on potential compliance concerns, and serves as a liaison to depts with compliance related responsibilities. Establishes and maintains working relationships with key individuals and depts.
• Develops working knowledge of compliance aspects and attends appropriate educational opportunities to maintain knowledge of relevant compliance topics. Monitors and reviews change to regulations, statutes, and governmental guidance for potential impact to organization.
• Assists in maintenance of revenue cycle controls and processes to ensure appropriate billing and payment. Assists with ensuring the timely refund of necessary paybacks.
• Works with the COI Administrator to support the effective and efficient operation of the COI program including review of disclosures, investigating, and reviewing conflict concerns, and developing conflict management plans.

Education Requirement:

Juris Doctorate, required.

Certifications:

Healthcare compliance certification, preferred.

Skills:

• Effective interpersonal and communication skills to collaborate with all levels within the organization.
• Excellent organizational and analytical skills, attention to detail, and ability to be an objective observer.

Experience:

• One year of experience in a compliance, regulatory, or legal field, required.
• Experience with electronic medical records, Internal Classification of Diseases (ICD 10), HCPCS, CPT coding principles and guidelines, preferred.

Physical Requirements:

OCCASIONALLY: Lifting / Carrying: 0-10 lbs, Standing, Walking

FREQUENTLY: (none specified)

CONTINUOUSLY: Audible speech, Computer skills, Decision Making, Flexing/extending of neck, Hand use: grasping, gripping, turning, Hearing acuity, Interpreting Data, Problem solving, Repetitive hand/arm use, Seeing – Far/near, Sitting

"The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individuals so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under their supervision. EOE M/F/Disability/Vet"