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    Manager, Compliance and Privacy Program - Phoenix, United States - Phoenix Children's

    Phoenix Children's
    Phoenix Children's Phoenix, United States

    1 week ago

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    Description


    When you join the healthcare team at Phoenix Children's, you'll see the world of medicine through the eyes of a child.

    You'll be amazed by something new every day, inspired by the capabilities and expertise of your co-workers, and you'll be able to transform your professional ambitions into realities.

    Here, you can be part of a growing system that will never outgrow its sense of joy, purpose or discovery.

    Come grow with us.

    We're looking for lifelong learners who transform curiosity into discovery to join us in an inspiring place—filled with hope, positivity, support and compassion.

    This position assists the VP and Compliance Director of Office of Business Integrity to direct and oversee the Phoenix Children`s Hospital ("PCH") Business Integrity Program


    The Manager will:

    Execute and lead the compliance program as approved and directed by the Chief Compliance Officer and Chief Privacy Officer, PCH Board of Directors and Senior Vice President, General Counsel by ensuring the development, implementation, and ongoing monitoring of the Compliance Program with a particular emphasis on AHCCCS billing compliance and compliance related education for PCH.

    Critical to the success of this role, the Manager is responsible for independently assessing a variety of complex compliance risk-areas with PCH to develop the Compliance Department's work plan.

    Responsible for independently performing scheduled audits required by the audit plan unplanned investigations and in carrying out these activities independently providing compliance guidance to PCH staff.


    Primary Duties:


    Monitors the performance of the compliance and revenue integrity programs and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.

    Prepares regular reports, as requested by the Senior Vice President, General Counsel, and Board of Directors, detailing compliance initiatives, accomplishments, trends, statistical data, etc.

    Recommends improvements/changes in the overall compliance program.

    Oversees compliance strategic planning and risk assessment activities, including the analysis and interpretation of the OIG Work plan, development of a system-wide annual compliance work plan and the annual audit work plan, and assistance to the operating units in developing departmental work plans.

    Develops, oversees, and maintains auditing and monitoring program of system-wide high-risk areas in compliance related and billing processes.

    Researches and develops system-wide benchmarks and assures the communication of review findings and alignment of best practices, as relevant, throughout the system.

    Develops corrective action plans to ensure resolution of risk areas.

    Collaborates with other departments, including, but not limited to, Human Resources, Quality, Research, Information Systems, and others, for system-wide integration of compliance programs.

    Develops audit work plans and conducts or supervises both planned and special audits of privacy related matters, patient medical records and bills to determine whether charges being billed are adequately supported by documentation in the record and that documented services are being billed and reported, including identification of potential system-wide areas of compliance vulnerability and risk, and development of corrective action plans.

    Reviews threshold communications from federal, state, or local agencies or from private payors regarding the payment process or the conduct of business, in collaboration and as applicable with the PCH Legal Department.

    Assists the operating units in responding to such inquires and investigations.
    Effectively directs outside vendors in completing audits assigned and approved with the Audit Plan.
    Prepares and assists conducting education for any applicable areas for which Compliance education efforts have been identified. Ensures all confidential and proprietary information and activities are handled discretely and information is safeguarded.

    Education Requirements:
    Bachelor's degree in healthcare, business or other applicable field.
    Master's Degree preferred

    Experience Requirements:
    Minimum of five (5) years of experience in healthcare (clinical or otherwise), coding, auditing, utilization management or related experience.
    Two (2) years of supervisory or managerial experience in healthcare.

    Experience in solving problems and communicating effectively with all levels of staff, managers, directors, senior management as well as leadership skills.

    Experience with CMS billing requirements, coding, HIM, hospital, and physician practice guidelines, and other applicable regulatory bodies.

    Experience and working knowledge of Corporate Compliance, Audit, Legal, Private, or Information Security Experience with case investigations and compliance hotline management.

    Preferred

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