Address
Form of work
SalaryGeneral Summary: Responsible for the oversight of the health system’s enterprise-wide compliance program and serves as the Compliance Officer for the Sheppard Pratt Foundation and its various entities. Works to assure that the enterprise functions in a legal and ethical manner while meeting its mission. Develops the health systems’ compliance plan to include program goals, policies, training and communication, data collection and reporting. Assures through staff delegation appropriate investigation and resolution of compliance complaints and issues; ongoing audits of medical record, billing and documentation and quality reviews; regulatory and accreditation compliance and survey readiness; and related issues. Keeps the CEO and executive management apprised of opportunities, challenges, and risks/concerns.
Essential Job Functions:
1. Customer Relations
- Maintains effective communication with enterprise leadership and the Board of Trustees.
- Actively seeks to provide quality services that meet the needs of patients and clients as well as other customers - payers, families, referrers, and staff.
2. Policies
- Develops and reviews the enterprise’s policies from a compliance focus.
- Works with health system leaders to interpret regulatory and accreditation requirement and develop policies and procedures that operationalize these requirements.
3. Audit Plans
- Oversees annual enterprise audit plan, in consultation with hospital QA.
- Provides oversight, through appropriate delegation, to program billing audits and the professional fee billing/coding for Medicaid/Medicare and other payers.
- Creates and manages effective action plans in response to audit discoveries.
4. Regulatory/Accreditation Compliance Oversight
- Stays abreast of outcomes of all licensing visits and surveys.
- Oversees the Community Program’s CARF accreditation survey process and stays abreast of the hospital’s TJC accreditation survey process.
- Oversees application for deemed status and conditions of participation during the award period. Stays abreast of updated information for presentation to the core service agencies.
- Assures the preparation of Performance Improvement Plans for areas cited in surveys.
5. Staff Education/Training
- Responsible for establishing and coordinating proper reporting channels for compliance issues.
- Assures that all employees receive required compliance training.
- Assures communication/training so that all employees are aware of various ways that they can report concerns about compliance, including anonymous reporting.
6. Concern line Investigations - Oversees the resolution of employee concerns about legal compliance.
7. Reporting
- Reports independently to the CEO and executive team on all compliance matters and relevant issues.
- Develops and is responsible for the annual review and revision of the enterprise Compliance Plan.
- Leads implementation and enforcement of the enterprise’s compliance program.
- Prepares quarterly and periodic reports as requested to board committees and health system leadership.
- Advises enterprise leadership on possible risks.
Other Duties: Completes system-wide and site-specific projects as requested.
Knowledge, Skills, and Abilities Required:
- Requires Bachelor's or advanced degree in law, finance, business administration, public health, or a related field and 5-7 years of relevant experience, including at least 3 years as a Compliance Officer. Master’s degree is preferred.
- Work requires strong interpersonal skills to direct staff, oversee or conduct investigations, assure problem resolution, represent the enterprise to a number of federal and state agencies, and report compliance to the board and executive leadership.
- Work requires a high level of analytical skills and attention to detail..
- Working with enterprise-wide plan requires attention to detail and deadlines and very frequently (51-80% of work time) produces a high level of mental/visual fatigue.
