PRINCIPAL DUTIES AND RESPONSIBILITIES
Under the direct supervision of the Executive Director of Corporate Compliance and within all applicable federal and state laws and regulations, as well as established policies and procedures, the Compliance Manager performs the following functions:
Works in conjunction with the Executive Director of Corporate Compliance to oversee and develop GOH system-wide compliance programs, with focus on implementing and maintaining the same on a day-to-day basis. Manages and administers all Compliance policies and procedures to ensure system integrity and compliance with applicable federal and state laws and regulations related to fraud and abuse. Ensures that all employees and agents of CMC and GOH affiliates abide by a Standard of Business Conduct. Prepare posters, newsletters, and other forms of communications, as appropriate, to ensure ongoing education and that compliance is engrained in the culture. Responsible for timely screening, addressing, and escalating all inquiries, questions, concerns, and complaints related to compliance issues. Provides consultative support to all levels of employees at CMC and GOH affiliates. Maintains a record of all such reports and ensures appropriate follow-through where required. Works with affected Managers, Directors and other leadership, both at CMC and GOH affiliates, to develop mechanism for preventing and detecting non-compliance. Responsible for maintaining confidential and anonymous reporting systems, and policies related to the same, to allow reporting of suspected noncompliance or incidents of fraud and abuse where employees or reporting individual wish to remain anonymous. Develops and performs training, education, and other preventative measures both as needed and on a routine basis pursuant to industry standards. Responsible for maintaining records of participation. Responsible for ensuring that new hires receive compliance training at orientation. Responsible for keeping abreast of all Office of Inspector General ("OIG") compliance guidance, fraud alerts, and other related information, as well as using the OIG's annual work plan to develop and implement internal audits and compliance projects. Prepares annual audit and monitoring plans for CMC and GOH affiliates. Performs special audits and related assignments as indicated or assigned, such as exclusion checks, HIPAA audits, and other compliance audits. Directly manages the Compliance Auditor & Educator. Ensures that all written summaries and detailed reports of all audits performed by the Compliance Auditor & Educator and Compliance Manager follow appropriate audit guidelines, standards, and best practices. Follows all RAC, ADR, CERT, and other external audit activity from initiation to closure and ensures that risk areas are further investigated, addressed, and remediated with applicable Departments. Works with the Executive Director of Corporate Compliance to create, and update on a monthly and quarterly basis, a dashboard of metrics for reporting to other CMC and GOH affiliate Departments, Senior Management, and the Corporate Compliance Committee.
- Bachelors Degree in Health Care or Business preferred. Commensurate experience may be considered.
- Requires five (5) years of previous experience in hospital compliance or a related department.