- Monitors the performance of the compliance, and revenue integrity programs and related activates on a continuing basis, taking appropriate steps to improve its effectiveness. Prepares regular reports, as requested by the VP and Director of Compliance and Privacy, detailing compliance initiatives, accomplishments, trends, statistical data, etc. Recommends improvements/changes in the overall compliance program.
- Develops, oversees, and maintains auditing and monitoring program of system-wide high-risk areas in compliance, privacy, 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.
- Oversees compliance strategic planning and risk assessment activities, including the analysis and interpretation of the OIG Work plan, assists in the 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.
- Manages specific risk assessments related to HIPAA and privacy compliance. Assists in privacy monitoring program and ensures ongoing monitoring of inappropriate/unauthorized access and disclosures through use of electronic record monitoring application features and data loss prevention applications in accordance with HIPAA Privacy Rules. Performs trend analysis and prepares summary reports on privacy monitoring activities
- Develops audit work plans and conducts or supervises both planned and specialized 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.
- Collaborates with other departments, including, but not limited to, Human Resources, Quality, Research, Information Systems, and others, for system-wide integration of compliance programs.
- Effectively directs outside vendors in completing audits assigned and approved with the Audit Plan.
- Prepares and assists conducting compliance and privacy 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.
- 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.
- Bachelor's degree in healthcare, business or other applicable field Master's preferred.
- Experience and working knowledge of Corporate Compliance, CMS/AHCCCS billing requirements, coding and auditing, , HIPAA, and other applicable regulatory bodies including the OIG, OCR, and DOJ.
- An understanding of Compliance practices within the Health Care Industry. Experience in solving problems and communicate effectively with all levels of staff, managers, directors, senior management as well as leadership skills.
- Minimum of five (5) years of experience in healthcare (clinical or otherwise), coding, auditing, utilization management or related experience.
- Experience with general healthcare compliance related activities including conflict of interest, compliance hotline management, and investigations.
- Effective Interpersonal skills.
- Ability to communicate effectively with a broad range of employee groups.
- Excellent writing skills to produce appropriate reports and recommendations.
- Strong analytical and critical thinking abilities.
- Strong knowledge base in Healthcare Revenue Cycle, Physician Documentation and Coding reviews.
- Ability to handle multiple priorities and change direction comfortably.
- Excellent oral and written communication skills.
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Manager, Compliance and Privacy Program - Arizona, United States - Phoenix Children's
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 the Office of Business Integrity to direct and oversee the Phoenix Children`s Hospital ("PCH") Compliance Program. The Manager will: Execute and assist in leading the Compliance Program as directed by the Compliance Director and Chief Compliance Officer by ensuring the development, implementation, and ongoing monitoring of the Compliance and HIPAA Privacy Program with an emphasis on AHCCCS billing compliance, compliance and privacy related auditing, and training and education for PCH. Critical to the success of this role, the Compliance Manager is responsible for independently assessing a variety of complex compliance and privacy risk-areas to develop the Compliance Department's work plan. Responsible for independently performing scheduled audits, investigations, and for the content and performance of the HIPAA Privacy Program and corresponding documents and polices on an ongoing basis and takes appropriate steps to improve their structure, performance and effectiveness consistent with industry standards. Works collectively with hospital management and other personnel to ensure the Corporate Compliance and Privacy Program initiatives are implemented across PCH.
Primary Duties:
Education Requirements:
Experience Requirements:
Special Skills:
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