Compliance and Integrity Manager

Position Status:

Full time

Shift:

First Shift (Days - Less than 12 hours per shift) (United States of America)

Hours per week:

40

Job Information
Exemption Status: Exempt

A Brief Overview
The Manager, Integrity and Compliance has responsibility for the daily direction, development, technical and operational leadership of programs within Stormont Vail Health's Compliance and Integrity program across the enterprise. The Manager will lead the organization's Integrity and Compliance Program including the design, development and implementation of initiatives, strategies and procedures to assure regulatory compliance, operational efficiency, cost effectiveness and reduction of risk. Additionally, the Manager will develop, implement and manage policies, processes, procedures and educational programs to drive overall compliance with applicable laws, regulations, rules and accreditation requirements, including but not limited to coding, billing and medical record documentation, code of conduct and ethics. This position will partner with subject matter experts and operational leadership to ensure a shared understanding of and consistent compliance with rules, regulations, policies and practices that apply to employees across the organization, as well as effective implementation of SVH's policies, procedures and strategies to strengthen and provide corporate compliance. The Manager assists the leaders of assigned areas with oversight of the organization's Program. The Manager is expected to function through an objective process of monitoring, reviewing, and evaluating compliance issues/concerns as well as developing and implementing the necessary procedures for preventing them. The Manager also indirectly assists and guides dozens of directors and managers in their roles in support of the Program. By serving as an independent and objective agent to these individuals, the Manager is able to monitor, review, evaluate, and resolve compliance questions and concerns and address applicable rules and regulations. The Manager regularly reports to the Stormont-Vail HealthCare, Inc. leaders as well as other system-wide councils, committees or governing bodies as necessary.

Education Qualifications

• Bachelor's Degree Business Administration, Business Law or related field. Required

Experience Qualifications

• 3 years Healthcare experience as a compliance officer, manager or related position. Required
• 2 years Experience with incident or event investigation. Required
• Experience with audits/quality control in a compliance, coding and billing environment. Preferred
• Management experience specific to compliance programs, billing and coding auditing, HIPAA, False Claims Act, Stark laws, etc. Preferred

Skills and Abilities

• Knowledge of state and federal regulatory requirements, laws and concepts, and OIG-DHHS seven elements for an effective compliance program. (Required proficiency)
• Goal-oriented, organized team player. (Required proficiency)
• Accurate and precise attention to detail. (Required proficiency)

Licenses and Certifications

• Drivers License - DMV Current Valid Driver’s License and Clean MVR with 3-year baseline and annual MVR review. Required

What you will do

• Develop, implement and maintain corporate compliance policies and practices used across Stormont Vail Health. Orient and train leaders to assure compliance with Stormont Vail Health’s policies and procedures related to the compliance program and applicable law, rules, regulations and policies to promote a culture of compliance.
• Supervise compliance training in laws such as CMS billing and coding requirements, Stark, Anti-kickback, HIPAA, and related state laws to inform employees of the applicable ethical and legal standards. Assist HIPAA Privacy Officer in carrying out their responsibilities.
• Review and investigate allegations of non-compliance and violations of laws, regulations, rules and policies and implement corrective actions as warranted and necessary.
• Define, design and implement policies, processes and educational programs, as well as partner in collaborative projects to propose, design and implement solutions/programs/protocols aimed at maintaining and promoting a culture of compliance and integrity.
• Develop, implement and manage program budget(s) to support effective financial planning, expense management and cost efficient program management.
• Monitor and take steps to assure the cost effective management of the compliance program providing oversight and direction to team members, conducting program assessments, monitoring program performance indicators and results.
• Prepare, analyze and distribute performance data and reports related to performance of internal program operations against industry benchmarks, comparative data and established performance targets; develop and implement plans of correction or improvement in order to address findings.
• Ensure that compliance audits, reviews and assessments are conducted to maintain compliance with federal, state and accreditation regulatory requirements including but not limited to CMS, DOJ, OIG, Kansas Department of Health and Environment, Joint Commission, etc.
• Travel to Stormont Vail Health worksites and other locations, as necessary, to carry out the responsibilities of the role and promote positive engagement in the compliance program across the enterprise.
• Conduct detailed and comprehensive risk assessments, perform analysis and develop recommendations for organizational action to mitigate, manage and eliminate organizational risks of potential non-compliance.
• Organize, plan and lead the development and implementation of an organization-wide compliance program, including establishment of annual goals and performance targets as well as tracking completion and evaluating effectiveness of activities intended to achieve compliance objectives, reduce risk and promote and enhance a culture of compliance across the organization.
• Develop, implement and manage the organization’s internal system of auditing coding and billing submissions to ensure such are accurate, timely, appropriately documented and meet all regulatory requirements in support of payment and implementing education and corrective measures where and if warranted.
• Maintain current knowledge of trends and practices and remain apprised of industry standards, technology developments and regulatory changes to incorporate best practices into the Stormont Vail Health programs and processes to continuously improve and promote compliance across the organization.
• Take steps to enhance organizational learning and to enhance compliance knowledge and adherence to applicable requirements, presenting information to all levels of the organization from the Governing Body to frontline staff.
• Establish and implement practices and processes that effectively and accurately determine the facts related to reports and allegations of non-compliance based on witness interviews, site inspections, review of audio/video recordings/documents and collection of other evidence.
• Monitor and proactively assess the impact of legislative, regulatory or case law changes that have the potential to impact the compliance program and recommend/implement approved program changes to support program continuity and adaptation to new program requirements. Carry out due diligence on new healthcare businesses before they are acquired and design effective integration plan.

Travel Requirements

• 10%

Required for All Jobs

• Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
• Performs other duties as assigned

Patient Facing Options

• Position is Not Patient Facing

Remote Work Guidelines

• Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
• Stable access to electricity and a minimum of 25mb upload and internet speed.
• Dedicate full attention to the job duties and communication with others during working hours.
• Adhere to break and attendance schedules agreed upon with supervisor.
• Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Remote Work Capability

• On-Site; No Remote

Scope

• Has Supervisory Responsibility
• Has Budget Responsibility

Physical Demands

• Balancing: Rarely less than 1 hour
• Carrying: Rarely less than 1 hour
• Climbing (Stairs): Rarely less than 1 hour
• Driving (Automatic): Rarely less than 1 hour
• Eye/Hand/Foot Coordination: Frequently 3-5 Hours
• Feeling: Rarely less than 1 hour
• Grasping (Fine Motor): Occasionally 1-3 Hours
• Grasping (Gross Hand): Rarely less than 1 hour
• Handling: Occasionally 1-3 Hours
• Hearing: Frequently 3-5 Hours
• Kneeling: Rarely less than 1 hour
• Lifting: Occasionally 1-3 Hours up to 10 lbs
• Pulling: Occasionally 1-3 Hours up to 10 lbs
• Pushing: Occasionally 1-3 Hours up to 10 lbs
• Reaching (Forward): Rarely less than 1 hour up to 10 lbs
• Reaching (Overhead): Rarely less than 1 hour up to 10 lbs
• Repetitive Motions: Occasionally 1-3 Hours
• Sitting: Frequently 3-5 Hours
• Standing: Occasionally 1-3 Hours
• Talking: Frequently 3-5 Hours
• Walking: Occasionally 1-3 Hours

Working Conditions

• Infectious Diseases: Rarely less than 1 hour
• Noise/Sounds: Rarely less than 1 hour
• Other Atmospheric Conditions: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.