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Years of Experience
Date Last Verified
Manager of Regulatory Compliance The candidate in partnership with operational management and customers, will: Support efforts to identify, evaluate, communicate and, as needed, remediate compliance and regulatory questions or issues relating to revenue cycle management (“RCM”) of hospital operations, including guidance and support relating to compliance with federal health care programs; and, provide demonstrated ability and comfort working with and reporting to a broad spectrum of service lines and professionals, ranging from senior management to front line site and service leaders to clients and vendors. The position, based at company’s Central Business Office in Salt Lake City, Utah, will report to the Vice President of Regulatory Compliance & Audit. Day to day role will include: Coordinate, with other members of the Company’s Compliance, Ethics & Risk team, to understand and anticipate compliance and regulatory issues or risks and to determine proactive education and mitigation efforts. Support the comprehensive strategy and growth plans to ensure that the company exhibits and maintains robust and proactive Compliance, Ethics & Risk Management programs. Play an integral role in developing the company’s overall Compliance, Ethics & Risk Management programs, including ongoing assessments and evaluations of the Programs’ effectiveness and opportunities for additional growth. Research and opine on federal health care program (Medicare, Medicaid, Tricare, etc.) statutes, regulations, rules and guidance regarding reimbursement, condition of payments and other material requirements, with an emphasis on front and middle revenue cycle areas, such as: Emergency Medical Treatment and Labor Act, Advanced Beneficiary Notice, Medicare Outpatient Observation Notices, Patient Rights & Responsibilities, HIPAA Notice of Privacy Practices, Release of Information, Medicare Secondary Payer, Conditions of Participation as relating to RCM operations. Building relationships and conducting outreach with client compliance counterparts and revenue cycle leaders. Serving as a subject matter expert for hospital operations on behalf of the Compliance, Ethics & Risk team. Keeping current on relevant regulations and enforcement trends, specifically as they relate to hospital operations compliance, including, but not limited to: Department of Health and Human Services (HHS); Office of Inspector General to HHS (OIG); Centers for Medicare and Medicaid Services (CMS); Office of Civil Rights (OCR); and, Other relevant state OIG and related offices/agencies. Working with the Compliance Audit team to develop ongoing auditing and monitoring in the areas of hospital operations. Assisting in the development of the annual compliance work plan sections relating to hospital operations. Preparing and providing hospital operations compliance education. Evaluating current policies, procedures and regulatory-specific education and training for company employees and contractors and, as needed, developing or revising such policies, procedures and education/training offerings. Developing and delivering regulatory compliance related training to workforce members to satisfy contractual requirements and foster a value driven culture. Building strong relationships with clients, employees and consumers that promotes trust and respect, demonstrates exemplary leadership and deep subject matter expertise. Other duties as assigned.
Qualification and Experience
The candidate should have Juris Doctorate from an ABA-accredited law school. Should have knowledge of Federal health care program statutes, regulations, rules and guidance regarding reimbursement, condition of payments and other material requirements. Must have 3 years of healthcare regulatory, compliance and/or patient access experience or extensive coursework with a focus on healthcare regulatory and/or compliance matters. Should have experience in performing legal and/or regulatory research and communicating important guidance and requests for follow up to a broad network of stakeholders and employees. Must have proven success at building relationships and credibility quickly with key stakeholders and subject matter experts. Experience in operational and project management is needed. Must have excellent computer skills with strong proficiency in spreadsheet applications and experience with Microsoft Office suite.
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