MGR - COMPLIANCE

DEPT: CORPORATE COMPLIANCE

LOCATION: 110 N MAIN ST, DAYTON, 45402

Full-Time / 8:00 am - 5:00 pm / DAY SHIFT

The Compliance Manager (CM) assists with all hospital and PPN compliance, including but not limited to, policies and procedures, auditing and monitoring, enforcement and corrective action, and education of Premier workforce. CM is the coordinator of all Compliance standards for Premier Health. The CM provides leadership in matters of compliance and the implementation and enforcement of the federal rules and regulations that govern compliance. CM identifies and reports the status of compliance issues and recommends policy changes to various internal committees. CM may audit and investigate identified compliance at Premier entities. CM is responsible for the administration of the incident tracking database, Conflict of Interest Process, excluded provider checks, and drives the compliance data analytics program. CM serves as a resource for all levels of the organization to aid with compliance issues. CM provides direct oversight for compliance related activities, training, investigating compliance incidents, auditing, and executive reporting.

Knowledge/Skills

• Strong written and oral communication skills required
• Ability to research and evaluate information
• Strong attention to detail
• Knowledge of CPT’s, APC’s, DRG’s and HCPCS Codes is preferred
• Advanced knowledge of Health Insurance Portability and Accountability Act of 1996 (HIPAA) required.
• Current knowledge of hospital billing is preferred
• Current knowledge of Medicare and Medicaid regulations is required
• Current knowledge of IT standards and processes required
• Knowledge of general hospital and physician clinic operations; understanding of financial management and reporting in healthcare.
• Strong interpersonal skills to interact with colleagues and professional organizations
• Ability to prioritize and coordinate multiple projects simultaneously
• Must demonstrate good judgement and diplomacy
• Maintain a high degree of confidentiality
• Advanced knowledge of Microsoft Office Applications required (Excel, Word, PowerPoint etc.)
• Ability to work in a team environment

Essential Duties & Functions:

· Coordinates/oversees auditing and monitoring functions for PH Corporate Compliance to ensure compliance with governmental programs.

· Performs/oversees ICD-9, ICD-10CM, CPT, HCPCS, chart to bill, Privacy, Information Security and/or billing procedures audits or investigations, and/or monitor activities, both prospectively and retrospectively. This includes retrieval from the electronic medical record of the required records, completing the audit/investigation and producing written summaries.

· Presents issues/educational topics to the internal committees, as needed.

· Coordinates audits performed by external auditors related to Compliance activities.

Kneeling 2 - Occasionally (11% - 40%) Normal hearing both ears 4 - Consistently (76% - 100%) Thinking 4 - Consistently (76% - 100%)

· Coordinates/oversees hospital wide compliance educational programs to ensure compliance with all regulatory bodies.

· Prepares/Facilitates reporting to appropriate areas both internally and to any required external reporting agency.

· Prepares evaluations of direct reports and develops professional growth plans for compliance personnel.