SYSTEM COMPLIANCE OPS OFFICER

Employer
Yale New Haven Health
Location
New Haven
Salary
Competitive
Posted
Jan 14, 2018
Closes
Feb 11, 2018
Industry
Education
Employer Type
Direct Employer
Employment Type
Permanent
Hours
Full Time
Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion-must guide what we do, as individuals and professionals, every day.

The System Compliance Operations Officer reports to the Vice President, Chief Compliance & Privacy Officer. He/she is authorized to operationally implement key aspects of a comprehensive compliance program ensuring that the eight elements of an effective compliance program are met and risk areas are monitored. In accomplishing his/her activities, the System Compliance Operations Officer and his/her representatives are authorized to have full, free and unrestricted access to all Yale New Haven Health System functions, records, property and personnel relevant to the subject under review. Works to develop strong relationships across the System with key departments including YMG Compliance Director, Internal Audit, Epic/ITS, JDAT, Legal, Revenue Management, SBO and clinical department leaders. Oversight for the development, implementation and continuous process improvement of a comprehensive compliance program operation (specific areas of focus listed in job responsibilities). Works collaboratively with the compliance team and other key department leaders to develop an annual work plan in collaboration with Internal Audit based on compliance risk areas identified by government audits, internal reviews, and based on the results of the enterprise wide risk assessment annual review. Oversees education efforts across the system on compliance risk areas and how to contact the compliance team. Prepares and presents regular reports of compliance program operations to management, senior leadership and System Compliance Committee. Supervises staff.

EEO/AA/Disability/Veteran

Responsibilities
  • 1. Supervises staff who assist in compliance program operations efforts including Compliance specialists, Compliance Coordinator and Pharmacy Compliance Specialists.
  • 2. Participate in and oversee the process for development of an annual compliance workplan and ongoing monitoring of workplan activities.
  • 3. Serve as a liaison to Internal Audit and Internal Controls in overseeing or performing joint audits, preparing the information to be presented to leadership and oversight committees.
  • 4. Develops and implements a comprehensive compliance education program that trains employees and other workforce on compliance risk areas such as fraud and abuse, anti-kickback, Stark, medicare and Medicaid reimbursement and documentation requirements, conflicts of interest, gifts and gratuities and other compliance risk areas.
  • 5. Oversees the development of educational tools to assist providers in documentation efforts, specifically targeting challenging areas for billing compliance and partners with the Associate Compliance Officer to ensure that educational tools are meeting compliance needs.
  • 6. Develops effectiveness measurement systems to assess the compliance training efforts.
  • 7. Implement and regularly assess effectiveness of physician/hospital contract management process to mitigate Stark and other compliance risks.
  • 8. Oversees the specialty pharmacy compliance program efforts and works collaboratively with Specialty Pharmacy management and staff.
  • 9. Ensures that a complete exclusion screening process is in place and is monitored.
  • 10. Investigates reported noncompliance and resolves problems on a timely basis.
  • 11. Continually assesses risk areas related to organizational and employee conflicts of interest. Implements the YNHHS Conflict of Interest policy, makes changes to the policy and processes as needed to reduce risk, trains staff.
  • 12. Collaborates with compliance representatives within the Office of Privacy and Corporate Compliance to develop effective risk assessment processes at departmental levels as needed.
  • 13. Implements and oversees process for management and communication regarding the compliance hotline. Trends data regularly to identify risk areas and reports information to management and oversight committees.
  • 14. Works to develop strong relationships across the System with key departments including YMG Compliance Director, Internal Audit, Epic/ITS, JDAT, Legal, Revenue Management, SBO and clinical department leaders.
  • 15. Participates in outside healthcare compliance organizations to stay abreast of corporate compliance developments and best practices within the industry.
  • 16. Actively participates in departmental and team meetings.
  • 17. Strives to continually improve the compliance program.
  • 18. Responsible for supervision, staff development, and training of OPCC staff positions.
  • 19. Develops personal and departmental goals and objectives consistent with those of the Yale New Haven Health System in conjunction with the Chief Compliance & Privacy Officer.
  • 20. Coordinates with legal counsel and management to maintain appropriate privacy and confidentiality, related to attorney client privileged information.
  • 21. Serve as the compliance lead for LM, WH and VNA.
  • 22. Provide leadership oversight of certain compliance or other subcommittees including developing agendas, maintaining minutes and ensuring that the work of those committees is completed timely.
  • 23. Serve as project lead/manager for projects on the annual workplan and/or under the scope of the OPCC.
Qualifications
EDUCATION

Bachelor's and Master's degrees required in nursing or another clinically focused area, business administration, healthcare administration, or a related field of study. CPT and ICD-10-CM proficiency. Demonstrated success in provider training and skills in change management and adult learning methods.

EXPERIENCE

Five to seven years experience in hospital and physician practice coding, charging, and billing required.
Experience with faculty practice plan and academic training program required.
Knowledge of Medicare and Medicaid billing regulations and fraud and abuse laws required.
Knowledge of eight elements of compliance programs.

LICENSURE

Registered nurse or allied health professional license preferred.
CCS, CPC, RHIA or equivalent coding certification preferred, CHC or other compliance certification required.

SPECIAL SKILLS

Ability to lead a team of seasoned compliance professionals in delivering exceptional revenue compliance services to Yale New Haven Health System and Northeast Medical Group clinicians and administrators.
Superior communication skills in designing and delivering effective billing compliance training programs. Demonstrated skills in working with external regulators and private payers in resolving audits in an appropriate and expedient manner. Demonstrated understanding of compliance issues related to ambulatory and hospital services, business administration, billing requirements for private insurers, and federal programs and Medicare Part A&B billing requirements. Demonstrated leadership skills and effectiveness. Ability to research and interpret regulatory requirements and coordinate and monitor internal responses complaints, audits and investigations. Demonstrated organization, facilitation, communication and presentation skills. Ability to prioritize and plan work independently. Ability to interact with all levels of management.

PHYSICAL DEMAND

Standard office environment. Some travel may be required.

Company Description:

Yale New Haven Health System, through its Yale New Haven, Bridgeport, Greenwich and Northeast Medical Group Delivery Networks, provides comprehensive, cost-effective, advanced patient care characterized by safety and clinical and service quality.

Yale New Haven Health System, in affiliation with Yale School of Medicine and other universities and colleges, educates health professionals and advances clinical care.

In all of its work, YNHHS is committed to the communities it has the privilege of serving.

More searches like this