This position is responsible for assisting with overseeing and directing functions of compliance and privacy programs across the District and subsidiary operations. The Compliance and Privacy Manager has primary responsibility for assistance with maintenance of the compliance plan and policies; development, implementation and maintenance of the HIPAA Omnibus Rule; workforce education on Compliance and HIPAA; monitoring and performing audits and analyses. The compliance and privacy function measures and monitors compliance with laws, regulations, and rules for operating in health care, providers, and government.
Provides assistance to the Chief Compliance and Privacy Officer in system wide leadership, guidance, and support to promote compliance with laws, rule and regulations.
Assists in the development, revising and implementation of Compliance and HIPAA Privacy and Security policies and procedures.
Assists with overseeing the development and implementation of the compliance plan and monitors adherence to policies, procedures, and the plan and initiatives.
Assists with developing, coordinating and conducting educational programs on compliance and privacy for employees, managers, medical students, physicians and senior managers ensuring that the education are conducted in accordance with the District’s compliance plan.
Assure Business Associate Agreements (BAA) are revised per HIPAA Omnibus Rule changes and assure revised BAA are obtained within Rule requirements from all Business Associates.
Assure timely reporting of Breach Investigation and Breach Notification requirements.
Conduct organizational risk assessment annually for privacy and security rule and prepare report.
Serve as a key advisor to staff on privacy complaints, allegations and investigations both internally and externally from business associates and government agencies.
Ensures proper control systems are in place for areas of risk areas.
Assists with development of annual Compliance audit work plan for compliance, operational, and financial audits. Core areas of audit review include internal controls, documentation, coding, billing, regulations, HIPAA and privacy and security.
Ensures annual audit work plan is met with planned audit and monitoring as well as investigation into Compliance related issues.
Performs audits in accordance with accepted standards and reports all pertinent findings based on the outcome of the audit.
Assists with ensuring requests, inquires, and/or investigations by regulatory agencies are properly managed and coordinated internally. Timely response is paramount.
Participates in and documents investigations submitted thru the Compliance Hotline or Compliance office by employees, patients, physicians and the public.
Assists with monitoring changes in State and federal laws or rules for Compliance and HIPAA Omnibus in order to ensure the organization maintains superior compliance and communication to appropriate District entities of changes.
Reports audits, risks and violations to the Chief Compliance and Privacy Officer in a timely manner. Develops corrective action plans with appropriate department heads and monitors progress to such plans and updates Chief Compliance and Privacy Officer.
Interacts with senior managers, legal counsel, and committee members. Leads billing and privacy and security workgroups.
Researches, investigates, and analyzes compliance and HIPAA issues and renders professional advice to business areas.
Reviews areas previously audited to confirm proper corrective action or recommendation(s) have been implemented.
Develops quarterly reports of activities and results. Reports information to the Chief Compliance and Privacy Officer.
Assists the Chief Compliance and Privacy Officer in preparing an annual report summarizing compliance activities for the current year and assists in preparing an annual work plan for the next fiscal year based on OIG work plan, regulatory risk and changes in regulatory/billing environment.
Exercises discretion to ensure that information is provided as appropriate and maintains confidentiality.
Demonstrates the ability to dissect difficult problems, analyze the essential components and affect change.
Demonstrates the ability to lead and/or work effectively within teams comprised of subordinates, peers, supervisors and external parties. Requires the ability to investigate issues, gather feedback, build consensus and, when necessary, respectfully disagree.
Exhibits exemplary oral and written communication skills. This includes the ability to share information in an organized, clear and timely manner, both verbally and in writing; keeping peers, colleagues, staff, and Chief Compliance and Privacy Officer appropriately informed.
Displays effective interpersonal skills such as effective listening, appropriate use of style and language for audience, and productive processing of information.
Processes and synthesizes complex information in an analytical fashion and is able to communicate finding and results effectively. This includes effective verbal presentation and written analysis adjusting language and terminology to the needs of the audience.
Emergency duty may be required of the incumbent that includes working in Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or disasters, man-made or natural.
Bachelor’s degree in healthcare administration, accounting, public health law or related discipline required. JD or master’s degree preferred.
The individual shall possess previous experience in health care, including experience in a compliance manager role for a healthcare operation. Previous experience with hospitals and nursing homes is preferred. Knowledge of state and federal regulations and rules, medical terminology and proficiency with diagnosis and coding preferred. Proficiency with third party billing and documentation standards is required and must be proficient in reading inpatient and outpatient medical records and hospital and nursing home billing.
Certifications in Healthcare Compliance, and Privacy preferred
Demonstrates current knowledge of healthcare and government finance through ongoing professional development.