Manager of Compliance - Premier Physician Network

Education:

• Minimum: Bachelor’s degree in health information management, Business Administration, Healthcare Administration, or a related field.

Licensure/Certification/Registration:

• Certified in Healthcare Compliance (CHC) or must obtain certification within one year of employment.

Experience:

• Minimum of 7-10 years of progressive experience in healthcare compliance, preferably within a physician company setting.
• Demonstrated expertise in electronic health record (EHR) systems and the ability to quickly adapt to new systems.
• Proven experience with ICD-10 and CPT/HCPCS coding, as well as physician billing rules and regulations.
• Strong understanding of Medicare and Medicaid regulations.
• Experience working effectively with physicians, senior management, and staff at all levels of an organization.
• Experience adhering to professional standards and compliance with federal, state, and local regulations, as well as organizational policies and procedures, including Premier Health Bylaws, Rules, and Regulations.

Knowledge and Skills:

• Comprehensive knowledge of healthcare compliance laws, regulations, and best practices.
• Strong analytical, problem-solving, and investigative skills.
• Excellent interpersonal, communication (written and verbal), and presentation skills.
• Ability to prioritize and manage multiple projects simultaneously in a fast-paced environment.
• Proficiency in Microsoft Office 1 365 applications (Word, Excel, PowerPoint, Outlook, etc.).   
• Demonstrated ability to work independently and collaboratively as part of a team.
• Strong leadership, team management, and mentoring skills.
• Ability to handle confidential information with discretion and professionalism.

Responsibilities:

• Compliance Program Management: Lead and manage the daily operations of the Corporate Compliance Program for Premier Health's physician company, ensuring alignment with industry best practices and regulatory requirements. This includes developing, implementing, and maintaining comprehensive policies, procedures, work plans, and training programs.
• Risk Assessment and Mitigation: Conduct regular and thorough compliance risk assessments to proactively identify potential vulnerabilities and develop effective mitigation strategies. Investigate and resolve compliance-related incidents and issues, ensuring timely and appropriate corrective actions and reporting.
• Auditing and Monitoring: Oversee compliance auditing and monitoring activities for physician the company with a focus on coding, billing, documentation, and other key risk areas. Conduct detailed reviews of medical records, document audit findings, and prepare comprehensive written reports with actionable recommendations.
• Regulatory Expertise: Maintain current and comprehensive knowledge of relevant federal and state regulations, including but not limited to Medicare and Medicaid regulations, HIPAA, Stark Law, Anti-Kickback Statute, and other applicable healthcare regulations.
• Coding and Billing Compliance: Possess a strong understanding of coding and billing practices for the physician company, including ICD-10, CPT/HCPCS coding, APCs, DRGs, and other relevant coding and reimbursement methodologies.
• Training and Education: Develop and deliver engaging and effective compliance training programs for employees at all levels, including physicians, nurses, administrative staff, and other relevant personnel. Create and update training materials to reflect current regulations, best practices, and organizational policies.
• Collaboration and Communication: Foster strong working relationships with workforce members, physicians, business partners, and leadership across the organization. Communicate compliance-related information clearly and concisely through various channels, including presentations, written reports, and training sessions.
• Reporting and Oversight: Provide regular and comprehensive reports on compliance activities to the Chief Compliance Officer, senior management, and relevant committees. Oversee and report on key compliance functions, including conflict of interest disclosures, exclusion screenings (for board members, vendors, employees, and non-staff), compliance hotline management and resolution, work plan progress, annual reports, and responses to special requests or compliance guidance.
• Team Leadership: Supervise, mentor, and develop compliance staff, conducting performance evaluations, providing feedback, and creating professional development plans. Foster a positive and collaborative team environment.
• Policy and Procedure Development: Directly or indirectly responsible for the development, implementation, and maintenance of compliance policies and procedures that address relevant regulatory requirements and organizational risks.