COMPLIANCE OFFICER SNF

Skilled Nursing -

OVERVIEW:

Provides day-to-day and strategic oversight and management of the Compliance Program in assigned regions. This position provides technical and professional compliance expertise and advice to leadership, regional support teams, employees, committees and affiliates regarding current and emerging federal, state and local and internal healthcare compliance-related issues consistent with the system-wide Compliance Program.

RESPONSIBILITIES:

• Implement, oversee and manage the Compliance Program in assigned region that meets or exceeds the requirements of an effective compliance program, as defined in the Federal Guidelines and OIG Program Guidance publications
• Serves as the official contact and public representative for the Company in assigned region
• Provides assistance and/or information on program elements
• Serves as the official Compliance Program local and regional representative at internal and external meetings, presentations and subcommittee/taskforce activities
• Assists in the identification of emerging risk areas and to assist in the development of compliance risk assessments and investigations, internal controls, monitoring and audit tools, policies and procedures and effective corrective action plans
• Oversees the implementation, data collection, analysis and reporting of Compliance Program Effectiveness measures, Focus Audits, Self-Assessments, Conflict of interest and Exclusion monitoring, and other required reporting to leadership at the local and regional level as well as support accurate and efficient corporate reporting of program efforts.

QUALIFICATIONS:

• Previous experience as a Compliance Officer for a hospital, physician practice/group or health care system.
• Knowledge of Medicare and Medicaid, including documentation, coding, reimbursement methodologies, as well as extensive familiarity with the Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations, and compliance guidance.
• Experience in contract review and language.
• Experience in the ability to conduct thorough and complete investigations and experience in interviewing individuals during an investigation.
• Ability to identify issues, problems and critical factors, and develop methods for corrective action.
• Ability to formulate, develop and implement monitoring, auditing and investigative standards, and policies and procedures.
• Strong interpersonal skills, ability to manage in a regional structure, ability to develop and maintain effective working relationships with leadership and other site management, physicians, liaisons and other healthcare professionals, in order to promote compliance with policies, procedures, laws and regulations and Medicare, Medicaid, Anti-Kick Back, False Claims Act and Stark laws and other applicable regulations.
• Ability to provide Compliance education and training and consultation to a wide variety of healthcare professionals.
• Ability to organize, assemble, categorize, and prepare data for reporting purposes.
• Sound professional judgment; dependability; resourcefulness, accuracy.
• High degree of initiative; tact; and discretion.
• Knowledge and experience in information privacy laws, access, release of information, and release control technologies.
• Knowledge in and the ability to apply the principles of compliance effectiveness, project management, and change management.
• Demonstrated organization, facilitation, communication, and presentation skills.

EDUCATION / EXPERIENCE:

• Bachelor s Degree with Master s Degree or other graduate degree in healthcare or related field desired. Coding and auditing certification are a plus.
• Certification in Healthcare Compliance (CHC) strongly preferred; or ability to obtain certification within 1 year of employment.
• Minimum of two years of in-depth experience within healthcare operations, law, finance, coding/billing and or compliance programs either from a consulting perspective, hospital or healthcare system or comparable experience required.