We are seeking a Director of Physician Services Compliance PSJH to provide systemwide leadership and direction on long-range planning and leadership of the PSJH Physician Services Compliance Program, including specifically areas of laboratory, pharmacy, and clinical regulatory compliance services . Reporting to the Executive Director, Physician Compliance Services, this position recommends and implements an integrated program that will promote the identification of risks, establish the framework, direct the processes to detect and prevent non-compliant behavior and promote ethical and lawful conduct that is consistent with that which is required by regulatory agencies, PSJH policies and procedures and PSJH's Code of Conduct. The Director will work with the Executive Director of Physician Compliance Services to direct the monitoring and reporting processes of the PSJH ministries around laboratory, pharmacy, and clinical regulatory compliance services and to collaborate with others to promote a cohesive Compliance Program across PSJH whereby best practices are identified and consistently implemented.
In this position you will have the following responsibilities:
- Develop and implement an integrated and aligned physician services compliance work plan that is based on risks that are identified through the performance of an enterprise-wide risk assessment and employee effectiveness survey, and revise plan annually.
- Advocate for and create operational processes that incorporate the use of compliance data to drive efficiencies, quality of service, cost containment, and reduce operational risks.
- Support strategic initiatives and regional and health system integration by providing consultative services, as appropriate, to support intended outcomes to ensure compliance, quality, and to position PSJH strategically for success.
- Create and sustain an empowering environment that is nimble in a changing regulatory environment to promote a compliance program that is approachable, effective, visible and well-respected.
- Organize lab, pharmacy, and clinical compliance functions by establishing clear accountabilities and delegation of duties without creating silos to ensure collaborative teamwork and effective use of limited compliance resources in support of strategic initiatives, monitoring, and corrective action.
- Develop written reports and present them to executive management and to the appropriate committees of the boards, at least quarterly, to keep leadership and members apprised of work plan status, significant issues, privacy and hotline summary, audit activity, and education elements are included in comprehensive oral and written reports.
- Work with all operational areas within the System and local ministries, including Legal, Human Resources, Quality, Risk, Case Management to design an appropriate process for investigating, reporting and tracking policy related violations, and to provide guidance and oversight related to policy and process implementation as required resulting from new or revised regulations impacting various operational areas.
Required qualifications for this position include:
- Bachelor's Degree in related field Or equivalent educ/experience.
- 10+ years of experience in healthcare compliance with multidisciplinary health system.
- 8+ years of leadership experience.
- Broad and comprehensive knowledge of the elements of the Federal Sentencing Guidelines (Compliance Guidance(s)) that constitute an effective and cost-efficient compliance program, a working knowledge of healthcare laws/regulations such as the Fraud and Abuse laws, False Claims Act, the Stark Law, the Anti-kickback Statute and EMTALA.
- Knowledge of HIPAA, HITECH, and relevant state breach reporting requirements sufficient to ensure that reporting obligations are satisfied.
- General working knowledge and the ability to navigate through government oversight agency publications including the CMS Internet-Only Manuals (i.e. Benefit Policy; Claims Processing; and Program Integrity).
- Knowledge of the the Medicare Conditions of Participation (CoPs), and the CMS State Operations Manual.
- Extensive familiarity with the Department of Health and Human Services Office of Inspector General (OIG) Compliance Guidance(s) relating to the elements of the Federal Sentencing Guidelines and federal health care program requirements.
- Ability to perform detailed web-based research and online searches of laws, regulations, industry best practices, and governmental guidance (e.g., OIG's compliance program guidance and advisory opinions) that might affect the company's compliance practices.
- Eligible for Healthcare Privacy and Security Certification.
- Eligible for Professional Compliance Officer Certification.
- Certified in Health Care Compliance (CHC) required upon hire or within six months of hire.