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Years of Experience
Date Last Verified
Director, Compliance Management - Compliance Management Department Duties: Oversees the Corporate Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. Ensures the Board of Trustees, administration, providers and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets the company’s Code of Conduct. Functions as a channel of communication to receive and direct compliance issues to appropriate resources for investigation and resolution. Serves as an internal resource with which concerned parties may communicate compliance concerns. Serves as the focal point for LMH compliance activities. Monitors and reports results of the compliance efforts of LMH and in providing guidance for the Board and senior management team on matters relating to compliance. Together with the Corporate Compliance Committee is authorized to put into action necessary actions to ensure achievement of the objectives of an effective compliance program. Responsibility for seven fundamental elements of an effective compliance program. Reviews documents and other information that are relevant to compliance activities, including but not limited to, patient records, billing records, marketing and fund raising data of LMH, and contractual arrangements with other parties, including employees, professionals on staff, insurers, non-health system health care providers, independent contractors, suppliers, research sponsors, and agents, etc. Oversees and monitors the implementation of the compliance program. Reports on a regular basis to AVP, Clinical Excellence, the Corporate Compliance Committee, and Board of Trustees on the progress of implementation, and assisting Leadership in establishing methods to improve efficiency and quality of services, and to reduce the vulnerability of fraud, abuse and waste. Periodically revise and update the program in light of changes in the needs of the organization, and in the law and policies and procedures of government and private payer health plans. Develops, coordinates, and participates in a multifaceted educational and training program that focuses on the elements of the compliance program, and seeks to ensure that all appropriate employees and leasers are knowledgeable of, and comply with, pertinent regulatory standards. Ensures that independent contractors and agents who furnish medical services to the health system are aware of the requirements of the compliance program with respect to coding, coverage, billing, and marketing, among other things. Coordinates internal compliance review and monitoring activities, including periodic reviews of departments. Responds to government investigations and queries as the principal point of contact. Independently investigates and acts on matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems, ‘hot-line’ calls, or suspected violations) and any resulting corrective actions with departments, clinics, providers, agents and if applicable independent contractors Develops policies and programs that encourage Directors and employees to report suspected fraud and other improprieties without fear of retaliation. Reviews the results of pertinent internal audit reports and work closely with key managers to identify aberrant trends in the charge capture, coding and billing areas. Evaluate patterns that require a change in policy and forward these issues to Administration and the Corporate Compliance Committee to remedy the problem. Performs other duties as needed or assigned.
Qualification and Experience
Qualifications: Bachelor’s Degree with 3+ years' healthcare. preferred Master’s degree in Healthcare Administration; OR JD Degree. Certified in Healthcare Compliance preferred. Certified in Healthcare Privacy Compliance preferred. Demonstrates excellent verbal and written communication skills and attention to detail.
Req ID: 00017T
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