Address
Form of workOverviewConduct thorough investigations into potential healthcare and corporate compliance violations. Gather and analyze data, documents, and evidence related to compliance issues. Interview relevant stakeholders, including staff, patients, and witnesses. Prioritize patient safety and satisfaction in compliance investigations. Respond promptly and professionally to inquiries from patients, regulatory agencies, and other stakeholders. Stay current with healthcare laws, regulations, and industry standards. Interpret and apply legal and regulatory requirements to healthcare compliance investigations and valuate the level of risk associated with identified compliance issues. Prioritize investigations based on the severity of potential violations. Maintain detailed and accurate records of the investigation process. Prepare clear and concise reports outlining findings, recommendations, and corrective actions. Ensure compliance with reporting requirements for internal and external stakeholders. Effectively communicate investigation findings to legal teams, regulatory bodies, and internal departments. Collaborate with cross-functional teams and provide updates on investigation progress. Work closely with legal, human resources, internal audit, and other departments to address compliance issues. Collaborate with colleagues to share insights, experiences, and best practices. Work closely with legal counsel to ensure that investigations align with legal requirements. Provide support during legal proceedings related to healthcare compliance issues. Stay informed about new investigative techniques, tools, and technologies. Engage in ongoing training to enhance skills and knowledge in healthcare compliance. Assess and improve investigation processes to enhance efficiency and effectiveness. Monitor and follow up on the implementation of corrective actions and improvements. Provide recommendations for corrective actions and improvements based on investigation findings. Work with relevant parties to develop and implement strategies to mitigate compliance risks. Identify root causes of compliance issues and develop effective solutions. Implement preventive measures to reduce the likelihood of future violations. Develop and implement monitoring programs to ensure ongoing compliance in partnership with QAC team members. Review and Validate Documentation Accuracy: Compile and Examine various types of documents, such as reports, manuals, and policies, to ensure accuracy and adherence to established standards. Compliance Assessment: Evaluate documentation against regulatory requirements, industry standards, and internal policies to ensure compliance. Payor/ State/ Federal Investigations Support: Collaborate with legal and compliance teams to support documentation needs during federal investigations, ensuring all required information is accurately and promptly provided. Audit Trail Documentation: Establish and maintain comprehensive audit trails for documentation related to any potential corporate integrity agreements and federal investigations, facilitating transparency and accountability. Legal Compliance Documentation: Work closely with legal counsel to ensure that documentation meets legal compliance standards, especially in the context of ongoing federal investigations and related matters. Confidentiality and Security Protocols: Implement and enforce strict confidentiality and security protocols for handling documentation related to Payor/State/Federal investigations and corporate integrity agreements. Risk Assessment and Mitigation: Conduct risk assessments related to documentation in the context of payor/state/ federal investigations, identifying potential risks and implementing mitigation strategies to ensure compliance. Communication with Regulatory Authorities: With Chief Counsel serve as a point of contact for regulatory authorities during audits and investigations, managing documentation requests and ensuring timely and accurate responses. Documentation Remediation: Collaborate with relevant stakeholders to address and remediate any deficiencies or issues identified in the documentation as part of payor/state/ federal investigations or corporate integrity agreement reviews. Documentation Structure and Clarity: Assess the organization and clarity of documents and EMR setup including proper formatting, logical flow, and readability, to enhance user understanding. Cross-Functional Collaboration: Collaborate with different departments and teams to gather information and ensure that documentation accurately reflects the processes and procedures within the organization. Quality Assurance: Implement quality control measures to identify and rectify errors, inconsistencies, or gaps in documentation. Documentation Standardization: Work towards standardizing documentation practices and templates across different departments and service lines, promoting consistency and clarity. Continuous Improvement: Identify opportunities for improvement in documentation processes, tools, and methods, and recommend and implement enhancements accordingly. Participate in corrective actions. Training and Communication: Provide training and support to teams regarding documentation standards and best practices, and communicate any changes or updates in documentation requirements effectively. QualificationsMinimum of 7 years of work experience in a contract therapy setting is preferred; degree from an accredited College or University as a licensed Physical Therapy, Physical Therapist Assistant, Occupational Therapist, Occupational Therapy Assistant or Speech/Language Pathologist is preferred with licensure or eligibility for licensure in all states the company provides service. Minimum of 5 years of work experience in healthcare compliance is preferred, including ADR-denials management, CPT and ICD-10 coding knowledge, investigations, policy and resource development. Minimum of 3 years of work experience in a supervisory role is required. Proficiency and work experience in leading compliance investigations and incident response from start to resolution, and maintaining a comprehensive tracking system. Proven leadership skills in the healthcare field. Knowledge of and ability to perform skills related to management, planning, program development and budgeting. Excellent communication and interpersonal skills. Experience presenting to students, professional audiences, internal and external senior and executive leadership both virtually and in-person is preferred. Proficient use of personal computer and software applications used in job functions including but not limited to word processing, graphics, databases, spreadsheets, and electronic medical record systems. Working knowledge of navigating business intelligence and other data analytics platforms is preferred. Knowledge of basic business accounting and interpretations of financial statements. Must possess a thorough knowledge of Medicare, Medicaid, private pay, and any other governmental and regulatory agencies involved in skilled nursing, senior living, outpatient, pediatrics, and home health care. Must possess a good working knowledge of Medicare/PDPM/PDGM, Managed Care, value-based care or any other reimbursement systems as it relates to industry regulation affecting the organization as well as upstream and downstream partners. Must possess and/or obtain further certification through programs meant to develop additional expertise, including but not limited to MDS RAC-CT, COS-C, COQS, QCP, RHIT, etc. Ability to obtain or possesses certification to complete Medicare Outpatient Physical Therapy accreditation surveys is preferred. Must be able to communicate effectively with residents, responsible parties, communities, personnel and support agencies. Assumes responsibility for ongoing continuing education and professional development Communicates effectively and professionally in all situations with varying personalities of customers, potential new hires, employees and management Able to adapt to changes in the work environment, can handle various demands and unexpected events Maintain confidentially of company employee information Attention to detail to ensure accuracy and completion Identifies problems and resolves them in a timely manner Prioritizes work activities to ensure all tasks are completed in a timely manner Recruiter : Email Addressctorres@healthpro-heritage.comEmployment Type: FULL_TIME
General Description
The Vice President, in partnership with various leaders, oversees the development and monitoring of collaborative frameworks to mitigate organizational risk. This role leads investigations and incident response for the organization. This role also oversees and collaborates on the development of compliance related data analytics, business intelligence, and other automated systems to support the organization's Corporate Compliance Plan. The Vice President fosters process refinement associated with reimbursement, regulatory, and other compliance initiatives within the rehab agency and outpatient therapy environment, including the development of new and the evaluation of current compliance policy and educational programs associated with Rehab Agency Administration & Program Oversight in conjunction with other organizational leaders to achieve staff competency, and regulatory compliance, and survey accreditation.
Reports To: SVP of Regulatory and Compliance
This is a remote position; Pay rate range is $90,000 to $100,000.
ResponsibilitiesPrincipal Responsibilities and Duties:
Knowledge, Skills, and Experience Required:
