Privacy & Compliance Manager

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.

The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).

Pay Range:

$101,899.20 - $133,140.80

Scheduled Weekly Hours:

40

Position Overview

SUMMARY (Basic Purpose of the Job)

Serves as an expert in identifying, assessing, and investigating patient billing compliance and privacy risk by maintaining up-to-date knowledge of rules, regulations, authoritative guidance, and standards related to Capital Health's major billing and privacy compliance risks. Supports the Compliance Office's function as an independent appraiser by carrying out timely and accurate audits and investigations as directed by the Chief Compliance Officer, or their designee, for all audit issues, including billing, coding, regulatory compliance, the use and disclosure of Protected Health Information (PHI) and compliance with the policy and the assessment of business risk. Administers good judgement and decision making skills in regard to the department. Provides oversight supporting all services lines within Capital Health. Ensures communication and transparency across multiple departments and management across the organization. Complies with federal, state, and local legal requirements by studying existing and new legislation, enforcing adherence to requirements, and advising management on needed actions. Promotes proactive operational compliance by managing Capital Health's compliance self-monitoring program. Serves as a resource to operational management for billing compliance information and for guidance on privacy regulation and the application of Capital Health Privacy Compliance Policy and Procedure. Serves as a primary investigator of privacy related issues and supports other aspects of the Compliance Office investigation function.

MINIMUM REQUIREMENTS

Education: Bachelor's degree in healthcare, business administration, or related field required. Master's Degree or JD in healthcare, business administration, or related field preferred. Compliance Certificate preferred.

Experience: Five years of related experience in a progressively responsible role in a compliance, or legal field.

Knowledge and Skills: Expertise of Federal, State and other regulatory requirements. Knowledge of the Knowledge and expertise of Program of All-inclusive Care for the Elderly (PACE) programs. Experience in a large hospital, multi-hospital system, or related preferred.

Special Training: Intermediate computer skills.

Mental, Behavioral and Emotional Abilities: Demonstrates critical thinking and experience working as a partner with administrators and executives in the development and delivery of initiatives and management of matters related to compliance.

Usual Work Day:8 Hours  

ESSENTIAL FUNCTIONS

• Identifies, reviews, and analyzes policies, regulations, authoritative guidance including billing manuals, State and Federal privacy guidance and other regulatory information for federal health care programs, current procedural terminology code descriptions, and other materials relevant to compliance risk.
• Recommends to the Chief Compliance Officer and Director of Compliance audit issues for annual audit work plan and/or to comprehensively address Capital Health's risk profile. Prepares draft audit work plans as directed by the Chief Compliance Officer. Applies applicable rules to develop audit protocols, tools, and work papers to accurately assess compliance risk and to quantify compliance performance. Identifies necessary data and documentation to complete audits and obtains needed data and documentation in a timely manner. Analyzes data and documentation according to audit protocols accurately. Conducts interviews with staff, patients and others and performs on-site observations to obtain information about, and accurately assess operational processes, staff conduct, physical structures, and workflow dynamics. Prepares follow-up requests for necessary information or observations as indicated by data and information collected.
• Collaboratively implements the Capital Health Compliance Department Work Plan, including identifying risk areas, assessing control systems, auditing and assessing training. Makes recommendations to Chief Compliance Officer. Meets with Managers and Administrative Directors and/or Directors to kick off compliance assessments. Assesses compliance control systems and training programs to determine comprehensiveness and effectiveness. Prepares Departmental Score Cards for review and approval by Chief Compliance Officer. Provides guidance to Directors and Managers related to implementation of work plan. Provides compliance training to departments on an assigned basis.
• Analyzes and assesses information, data, and documentation obtained during the audit process accurately. Prepares accurate draft audit reports to meet audit plan deadlines. Reviews draft audit reports with Chief Compliance Officer including on proposed findings and recommendations for corrective action. Participates in meetings to review audit findings and recommendations. Collaboratively manage the audit process to ensure audit timelines and targets are met.
• Works at the direction of Chief Compliance Officer and Director of Compliance to investigate potential noncompliance related to State and Federal laws governing the use and disclosure of Personally Identifiable Health Information. Conducts interviews with staff, patients and others as directed.
• Acts as a primary point of information and expertise for privacy-related policy issues within the organization, and as assigned. Supports operational management by providing guidance on the implementation of privacy policy and the reduction of privacy risk. Conducts privacy reviews throughout the system. Makes recommendations to improve controls and reduce risk based on reviews.
• Acts as a primary point of contact for patient privacy complaints, interviewing patients, assessing concerns and assuring them of Capital’s commitment to protecting privacy and security of health information, in organizational area as assigned. Assesses patient privacy complaints and making recommendations to the CCO/Director of Compliance for an investigation plan.
• Demonstrates an ability to assess a situation from various perspectives and considers several alternatives and choose an appropriate course of action. Obtains all pertinent information to make an informed decision. Reviews and determines appropriate disposition of mail, faxes, and e-mails and responds to all requests in a timely manner. Protects the integrity and confidentiality of information at all times.
• Analyzes and tracks department participation and performance in compliance self-monitoring program. Works collaboratively with documentation and coding department regarding documentation, monitoring and auditing. Reports to the Chief Compliance Officer on a regular basis concerning participation and performance in compliance self-monitoring program. Provides education and training regarding billing compliance to operational units as directed by Chief Compliance Officer and in collaboration with appropriate departments. Identifies information system enhancements to promote compliance.
• Serves as a liaison to operational departments, as assigned, by educating directors, supervisors, and staff about implementing monitoring protocols, tools, plans. Serves as a model employee for compliant behavior. Promotes compliance through positive interactions with fellow employees. Obtains information through data requests, analysis, document review, and interviews with staff as directed by Chief Compliance Officer and Director of Compliance. Takes lead responsibility for investigations as directed by Chief Compliance Officer/Director of Compliance.
• Serves as a liaison the Capital Health LIFE program, which includes, overseeing, preparing and managing audits for Capital Health Life; audit to ensure credentialing requirements are being met; audit and review the CMS PACE program regulations to ensure compliance.
• Maintains work papers in a systematic and professional manner. Organizes working files in a manner to permit review and evaluation by third parties. Complies with office electronic and paper filing systems.
• Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include: Standing, Walking, climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, reaching forward, reaching overhead, Squat/kneel/crawl, Wrist position deviation, Pinching/fine motor activities, Keyboard use/repetitive motion, Taste or Smell, Talk or Hear
Occasional physical demands include:
Continuous physical demands include: Sitting
Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate HearingAnticipated Occupational Exposure Risks Include the following: Dust/Particulate Matter

This position is eligible for the following benefits:

• Medical Plan

• Prescription drug coverage & In-House Employee Pharmacy

• Dental Plan

• Vision Plan

• Flexible Spending Account (FSA)

- Healthcare FSA

- Dependent Care FSA

• Retirement Savings and Investment Plan

• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance

• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance

• Disability Benefits – Long Term Disability (LTD)

• Disability Benefits – Short Term Disability (STD)

• Employee Assistance Program

• Commuter Transit

• Commuter Parking

• Supplemental Life Insurance

- Voluntary Life Spouse

- Voluntary Life Employee

- Voluntary Life Child

• Voluntary Legal Services

• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance

• Voluntary Identity Theft Insurance

• Voluntary Pet Insurance

• Paid Time-Off Program

The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. 

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.