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Ethics & Compliance Consultant III

Sutter Health

Emeryville, CA

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JOB DETAILS
SALARY
$145,204.80–$217,796.80 Per Year
SKILLS
Americans with Disabilities Act (ADA), Analysis Skills, Auditing, Budget Management, Business Administration, Business Skills, Computer Skills, Consulting, Corrective Action, Cross-Functional, Crystal Reports, Data Analysis, Data Quality, Detail Oriented, Disease, Documentation, ERISA (Employee Retirement Income Security Act of 1974), Establish Priorities, Federal Government, Federal Laws and Regulations, Government, Government Regulations, HIPAA (Health Insurance Portability and Accountability Act), Healthcare, Healthcare Providers, Hospital Systems, Incident Response, Industry/Trade Analysis, Information/Data Security (InfoSec), Insurance, Interpersonal Skills, Legal, Maintain Compliance, Medi-Cal, Medical Billing, Medical Coding, Medical Records, Medical Terminology, Medicare, Metrics, Microsoft Excel, Microsoft Office, Microsoft PowerPoint, Microsoft Visio, Microsoft Word, Multitasking, Organizational Skills, Policy Development, Presentation/Verbal Skills, Problem Solving Skills, Procedure Development, Process Improvement, Project Planning, Quality Assurance, Regulations, Regulatory Compliance, Regulatory Requirements, Reimbursement, Risk, Risk Analysis, Risk Management, SAP, State Laws and Regulations, Team Player, Time Management, Trend Analysis, Writing Skills
LOCATION
Emeryville, CA
POSTED
10 days ago
We are so glad you are interested in joining Sutter Health!


Organization:


SHSO-Sutter Health System Office-Bay


Position Overview:


Works to assure compliance with Physician Self-Referral laws, Anti-Kickback statues, fraud, waste and abuse laws, and other compliance laws and the organization's policies and procedures. Works with and serves in the absence of the compliance officer in overseeing, coordinating, implementing, administering, and evaluating the Sutter Health ethics and compliance program at assigned entity(s). Collaborates with entity organizational staff, ethics and compliance staff, and legal & risk services team members regarding changes in federal and state laws and regulations for healthcare providers and the organization's policies and procedures. Plans, executes, and leads a variety of regulatory compliance based projects. Leads in the day-to-day management of ethics and compliance incident response process. Partners with the compliance officer to conduct and report on internal investigations and compliance risk assessments and assists with the development of compliance policies and procedures. Serves as a resource person to perform the various activities of the ethics and compliance program and includes monitoring, investigation coordination, data quality assurance, training and education, and managing any confidential reporting received via mailbox or phone messaging. This position will perform trending, analysis and metric reporting related to ethics and compliance incidents and make recommendations for control implementation, education opportunities and remediation.


Job Description :


The person selected for this role will support the following locations: CPMC, Mills Peninsula, Lakeside, Santa Rosa and other locations as assigned.


EDUCATION:

_Equivalent experience will be accepted in lieu of the required degree or diploma._


+ Bachelor's: Business Administration or related field


CERTIFICATION & LICENSURE:


+ CHC-Certified in Healthcare Compliance within 1 Year of hire

+ OR CHRC-Certified in Healthcare Research Compliance within 1 year of hire

+ OR Juris Doctorate within 1 year of hire


TYPICAL EXPERIENCE:


+ 5 years of recent experience.


SKILLS AND KNOWLEDGE:


+ In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting and documenting investigations, addressing violations, tracking corrective actions, and training.

+ In-depth knowledge of healthcare clinical operations, hospital revenue cycle systems, and healthcare billing and coding requirements.

+ Working knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources.

+ Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws.

+ Exceptional attention to detail with excellent time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines.

+ Strong business acumen and exceptional analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.

+ Excellent written/verbal communication, interpersonal, and presentation skills with the ability to translate complex legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences.

+ Proficient computer skills, including advance competency in Microsoft Office Suite (Word, Excel, Visio, Project, and PowerPoint), SAP SE Crystal Reporting, and other software.


Ability to:


+ Manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.

+ Identify potential concerns and compliance issues and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem.

+ Advise management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations.

+ Abstract information from medical records, reports, chart entries, related patient documentation, and interviews while conducting audits and investigations.

+ Work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established timeframes and government regulations.

+ Direct, prioritize, and drive multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget.

+ Make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.

+ Foster an open and collaborative environment that invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.

+ Maintain strict confidentiality of sensitive material (compliance and risk management data) and ensure the privacy of each patient’s protected health information (PHI).

+ Work effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.

+ Build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.


Job Shift:


Days


Schedule:


Full Time


Days of the Week:


Monday - Friday


Weekend Requirements:


As Needed


Benefits:


Yes


Unions:


No


Position Status:


Exempt


Weekly Hours:


40


Employee Status:


Regular


Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.


Pay Range is $145,204.80 to $217,796.80 / annual salary


_The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package._

About the Company

S

Sutter Health

Sutter Health has a long history in California. Some of our facilities have been providing care in the communities we serve for more than 100 years. Today, we’re proud to partner with more than 12,000 doctors to care for more than 3 million people.

We’re inspired by our Northern California community and work tirelessly to deliver top-rated, affordable healthcare. Doctors, hospitals, care teams and employees in the Sutter Health network are always looking for new, meaningful ways to care for you and your loved ones. We believe that every moment matters when it comes to helping you live a longer, healthier and happier life.

Our not-for-profit network delivers top-rated, personalized care in more than 100 Northern California communities. Recently ranked among the Top 15 Health Systems in the nation by Truven Health Analytics™, our team of more than 50,000 doctors, employees and volunteers partner to spread innovation, improve access to healthcare services and put our patients’ needs first—all to achieve the highest levels of quality, access and affordability.

COMPANY SIZE
10,000 employees or more
INDUSTRY
Healthcare Services
EMPLOYEE BENEFITS
Professional Development, 401K, Flexible Spending Accounts, Retirement / Pension Plans, Tuition Reimbursement, Life Insurance
FOUNDED
1921
WEBSITE
https://jobs.sutterhealth.org/