Diversified Compliance Officer Job Listing at MedStar Health in United States of America (Job ID 158903)

Description

About the Job

General Summary of Position
Responsible for managing the implementation of MedStar Health's Compliance and Privacy program and overseeing the operation of that function in one or more assigned diversified business entities. Serves as the privacy liaison for assigned MedStar clients. Implements MedStar Health's annual compliance work plans, systems, processes and policies designed to ensure compliance with Federal healthcare program requirements at the entity level.

Primary Duties and Responsibilities

• Acts as a consultative resource for the entity leadership and associates on compliance matters.
• Advises entity leadership on issues concerning compliance, including developing and implementing controls designed to ensure compliance with MedStar Health and OCBI policies and procedures. Works collaboratively with entity leadership in the development or restructuring of a compliance program and its implementation.
• Collaborates with OCBI/Corporate to oversee the coordination of internal and external governmental compliance/privacy investigations or reimbursement reviews (MACs, ZPICs etc.) at the local entity (and the Legal Department as necessary) to ensure investigations/reviews are conducted appropriately and/or that responses to external entities are appropriate and consistent with OCBI standards and expectations.
• Collects and provides data for monthly compliance data requests, dashboards, and scorecards.
• Communicates and works collaboratively with AVP of Diversified Businesses Compliance, Privacy Director, OCBI staff, system compliance leads, and Legal Counsel on compliance and privacy issues, resolutions, and identified trends.
• Coordinates OCBI compliance operations monitoring systems and processes for compliance tracking systems at the entity level.
• Coordinates with Legal Counsel on legal compliance matters and government investigations, as appropriate.
• Ensures distribution, implementation, and education regarding compliance policies, procedures, and the Code of Conduct (e.g. annual conflict of interest disclosure process Recovery Audit Contractor claim review processes, monthly healthcare exclusions screenings, Business Associate Agreement updates etc).
• Establishes an entity-level Compliance Committee to provide guidance and support on compliance issues and operationalizing compliance initiatives. Chairs the entity compliance committee and reports to the entity level leadership and Board on compliance matters and progress on a regularly established frequency.
• Identifies entity-level risk areas and assists in developing auditing, monitoring, and oversight processes related to the identified risks.
• Implements and oversees MedStar Health's compliance and privacy programs at the local entity level to ensure the program meets the requirements of the seven elements for an effective compliance program and is aligned with the OCBI/Corporate compliance and privacy program.
• Implements MedStar's fiscal year compliance work plan and initiatives at the entity level. As needed, develops entity-specific fiscal year work plan items in addition to the corporate work plan.
• Independently investigates or supervises the investigation of compliance concerns raised through MedStar's Integrity Hotline or other reporting mechanisms.
• Interfaces directly with entity employees and serve as a sounding board for compliance concerns.
• Oversees the implementation of corrective actions and monitoring in response to identified issues, audits, and annual work plan items.
• Oversees the implementation of the OCBI education and training programs (SiTEL and other mediums as appropriate).
• Participates in the development and implementation of annual compliance work plan, enterprise risk management program and aligns entity risk assessment with enterprise risk management plans.
• Works with entity-level leadership compliance committee members and department heads to establish a culture of compliance at the entity.

Minimal Qualifications
Education

• Bachelor's degree in relevant field required
• Master's degree preferred

Experience

• 5-7 years experience in healthcare compliance matters and experience in conducting investigations, performance of coding and billing reviews and auditing. In depth knowledge of healthcare compliance and privacy laws, regulations and guidance required

Licenses and Certifications

• CHC - Certified Healthcare Compliance Certification in healthcare compliance or another comparable compliance certification from a recognized industry professional association with a focus on regulatory compliance, auditing, monitoring etc. required
• Coding certification preferred

Knowledge Skills and Abilities

• Strong written and oral communication skills.
• Strong analytical and problem-solving skills.
• Proficiency in working with Microsoft Office products and other health care-related applications.
• Proven ability to manage multiple projects and deadlines.