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Public Interest
Attorney
Health Care
Min 5 yrs required
Deputy Compliance Officer The candidate will report directly to the CCAPO. Will be charged with the senior compliance operational and administrative oversight of the following: WCHN Audit functions including, without limitation, the management of all internal and external (e.g., government and regulatory body) compliance-related audits, as well as the management of the co-sourced internal audit function performed by WCHN's outside internal auditor KPMG; and supervision of the two senior compliance officers assigned to provide compliance oversight of the Quality, Clinical Audit, and Billing Cycle compliance activities; and Fraud, Waste and Abuse Prevention and Compliance Program Effectiveness activities. Responsible for assuming all CCAPO functions including, without limitation, oversight, supervisory, and administrative responsibilities, in the CCAPO's absence secondary to PTO, infirmary or otherwise.
Qualification and Experience
The candidate should preferably have Bachelor degree in Nursing (or other clinical discipline). Bachelor degree in Compliance, Accounting, Fraud Management, Public Health or Health Services Administration, Human Resources Management, Business Administration is desired. Master degree in any of the above-referenced concentrations, or a Juris Doctor degree a Master of Law degree from an American Bar Association accredited law school are strongly preferred. The candidate should have Bachelor degree and minimum of seven years or more job-related experience. Must have proficiency in Microsoft PowerPoint, Excel, and Word and Westlaw and/or LexisNexis legal information systems; clinical management and clinical audit experience in reviewing medical record documentation and billing. Must have k nowledge of hospital or other healthcare billing, coding and documentation guidelines and regulations and Knowledge of information systems, managed care, and revenue cycle. Must have verbal and written communication skills; ability to analyze data and investigational findings and summarize the same in a coherent, concise, and organized manner in both oral and written form; carry out work functions and duties in an independent manner with minimum supervision and the ability to collaborate with various levels of the WCHN workforce in accomplishing compliance goals; leadership skills; develop and direct Network-wide training and education programs; direct the performance of auditing and monitoring activities; past managerial and supervisory experience; time management skills and the ability to prioritize assignments. Should have high level of understanding of State and Federal billing cycle and fraud, waste, and abuse laws; high level of understanding of section 8B2.1 of the 2016 United States Sentencing Commission Guidelines Manual, the Department of Health and Human Services Office of Inspector General Compliance Program Guidance to Hospitals (63 Fed. Reg. 8987 (1998)), and Supplemental Guidance to Hospitals (70 Fed. Reg. 4858 (2005)), as well as other compliance program guidance and/or requirements established by regulatory bodies or applicable Federal and State law, respectively; understanding and knowledge of all applicable Federal and State patient and employee (and other WCHN stakeholders) confidentiality laws including, without limitation, HIPAA; and an understanding of physician and facility (inpatient and outpatient) coding (e.g., evaluation and management coding, diagnosis coding, CPT coding) billing, claims submission, claims reimbursement, and payments and compliance as it relates to revenue management. Must have Certification in: Healthcare Compliance ("CHC" designation) from the Compliance Certification Board within 3+ months of appointment (must be eligible to take the certification exam at the time of appointment); or (ii)(a) Compliance and Ethics ("CCEP" designation) from the Compliance Certification Board at the time of appointment; and (b) certification in Healthcare Compliance ("CHC" designation) within 15 months of appointment; and 2 (i) Certification in internal audit ("CIA" designation) from the Institute of Internal Auditors ("IIA") within 12 months of appointment; Risk Management Assurance ("CRMA" designation) from IIA within 12 months of appointment; or Fraud Examination ("CFE" designation") by the Association of Certified Fraud Examiners within 12 months of appointment; or (ii) duly licensed as a Certified Public Accountant ("CPA" designation) in the State of Connecticut within 12 months of appointment; and Registered as a Nurse in the State of Connecticut within 12 months of appointment or Certified as a Medical Audit Specialist ("CMAS" designation) from the American Association of Medical Audit Specialists within 12 months of appointment.
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