Compliance Officer Regional Hospitals

Compliance Officer Regional Hospitals

This position will require daily travel between four (4) hospitals. (GIRMC, KRMC, CAMC, & MMC)

GENERAL SUMMARY:

Assists corporate compliance leadership in all compliance activities at Kearney Regional Medical Center, Grand Island Regional Medical Center, Merrick Medical Center and Crete Area Medical Center. Responsible for developing and maintaining the compliance program at each assigned entity in accordance with the Office of Inspector General (OIG) Seven Elements of an Effective Compliance Program. Collaborates with each assigned entity’s compliance liaisons, leadership, senior leader teams, and the corporate compliance team.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Acts as an integral member of the compliance team, collaborating with Bryan Health Legal and Corporate Compliance team to develop, implement, and maintain effective compliance strategies and programs.

3. * Advises and educates the assigned entities and associated boards on regulatory compliance and the seven elements of an effective compliance program, in collaboration with the Chief Legal and Compliance Officer and Risk Management and Corporate Compliance Director.

4. *Responsible for the implementation, maintenance, and periodic evaluation of the compliance program for each assigned entity to ensure compliance with federal and state regulations, accreditation standards, and healthcare laws. This includes development and management of compliance work plans, risk assessments, auditing and monitoring activities, vendor compliance, annual education, compliance communications, and other program initiatives in collaboration with the corporate compliance team.

5. *Develops audit tools and establishes, oversees, and monitors annual billing, coding, documentation, and compliance audit plans by service area; conducts or coordinates audits and directs analyst activities for additional audits as needed in response to billing questions and payer audit inquiries, ensuring compliance with departmental guidelines and third-party payer requirements, including Medicare and Medicaid.

6. Oversees compliance with the Code of Conduct by reviewing, investigating, and managing reports of suspected misconduct, compliance concerns, and reporting line inquiries for assigned entities.

7. Partners with Legal, Compliance, Human Resources, and organizational leadership to ensure appropriate resolution of concerns. Reports confirmed misconduct to leadership and Human Resources for corrective or disciplinary action.

8. Coordinates with the local privacy officer to manage HIPAA privacy concerns.

9. *Documents compliance risks, investigations, reports, inquiries, and corrective actions through the corporate compliance matter management system.

10. *Provides compliance education to the entity Boards as needed and prepares and presents periodic reports on compliance program activities, initiatives, and significant compliance matters.

11. *Develops and implements policies, guidelines, and practices related to legal, regulatory, and ethical business requirements in collaboration with the corporate compliance team.

12. *Ensures timely and accurate distribution of compliance information and education on topics including billing, coding, documentation, Stark Law, Fraud and Abuse Laws, the Deficit Reduction Act, and other regulatory requirements in collaboration with the corporate compliance team.

13. *Monitors regulatory updates, including Office of Inspector General (OIG) work plans, Medlearn Matters publications, Medicaid manuals, and other governmental and industry resources, and disseminates actionable information in collaboration with the corporate compliance team.

14. *Maintains expertise in applicable federal and state laws, regulations, compliance guidance, and industry standards through ongoing professional development and routine review of regulatory resources.

15. *Provides education and training about regulations that affect operations, identifies operational obstacles to compliance, and works with leaders and other employees to identify and implement solutions.

16. *Provides on-site and ongoing compliance support to the regional hospitals, departments, and entity operations on billing, coding, documentation, and regulatory matters.

17. Assists, as needed, in the annual mailing to all Bryan Health vendors in order to meet the requirements under the federal Deficient Reduction Act for education on fraud and abuse.

18. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of the latest trends in the field of expertise.

19. Participates in meetings, committees, and department projects as assigned.

20. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

1. Knowledge of health care billing, particularly with respect to government payers (e.g., Medicare and Medicaid), and applicable regulations and provisions.

2. Knowledge of processes used in auditing patient billing and medical records for compliance with third-party payer requirements.

3. Knowledge of computer hardware equipment and software applications relevant to work functions.

4. Skill in supervising, mentoring, instructing, and evaluating the work of professional and other service/staff.

5. Ability to evaluate documentation, interpret regulations and policies and make decisions in accordance with established precedents or protocols.

6. Ability to find, read, interpret and explain Medicare and Medicaid regulations and healthcare provisions.

7. Ability to prioritize work demands and work with minimal supervision.

8. Ability to communicate effectively both verbally and in writing.

9. Ability to perform crucial conversations with desired outcomes.

10. Ability to problem-solve and engage in independent critical thinking skills.

11. Ability to maintain confidentiality relevant to sensitive information.

12. Ability to establish and maintain effective working relationships with all levels of personnel, medical staff and ancillary departments.

13. Ability to maintain regular and punctual attendance.

14. Ability to promote change toward the achievement of a shared vision, challenge current paradigms, and facilitate systems thinking.

15. Ability to act in a proactive manner while also providing crisis/situational management in an erratic and potentially unpredictable work environment.

EDUCATION AND EXPERIENCE:

Bachelor’s degree in nursing, allied health, law, business, or other directly related field required. Master’s degree preferred. Current Registered Nurse License in the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act preferred. Three (3) years of clinical, corporate compliance, or directly related experience required. Prior auditing experience and familiarity with Medicare and Medicaid rules strongly desired.

OTHER CREDENTIALS / CERTIFICATIONS:

Healthcare Compliance certification within eighteen (18) monthsof hire.

PHYSICAL REQUIREMENTS:

(Physical Requirements are based on federal criteria and assigned by Human Resources upon review of the Principal Job Functions.)

(DOT) – Characterized as sedentary work requiring exertion up to 10 pounds of force occasionally and/or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

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