Vice President Reimbursement Compliance

Major Responsibilities: 

• Assists the Chief Compliance and Privacy Officer in planning, designing, implementing, and maintaining a Compliance Program that promotes a culture of ethics and compliance within all entities owned and controlled by Advocate Health and overall compliance with laws, regulations, rules, guidance and accreditation standards. 

• Oversees the ongoing review and monitoring conducted by the reimbursement analysis and monitoring (RAM) compliance team for hospital, shared services and physicians/providers.  Works closely with the leadership in Revenue Cycle, Managed Health, and Finance to ensure compliance with applicable federal / state regulations and contractual requirements involving documentation, coding, and billing of healthcare services.

• Oversees the Compliance Program’s review and monitoring of Advocate Health’s value-based contracting, including Accountable Care Organization, compliance.  

• Oversees the operations component of the Compliance Program across the Advocate Health Medical Group and ensureoperations align with industry standards and promote compliance with federal and state laws, regulations, rules and applicable guidelines. 

• Working closely with Medical Group and Finance, manages the compliance components of physician compensation and contracting ensuring adherence to applicable federal and state laws and regulations.

• Oversees the Compliance Program’s data analytics program and develop reports and tools that supplement the monitoring efforts of the compliance team.

• Overseesthe Compliance Program’s education and awareness activities, including the Compliance Program’s website and guidance documents, designed to educate teammates and correct / prevent issues related to regulatory compliance and ethical conduct. 

• Reduces organizational risk by overseeing risk assessments as part of the system-wide compliance risk assessment process and by defining and overseeing audits and other compliance work plan activities to mitigate identified risks. 

• Serves as internal expert and advisor in compliance matters related to regulations affecting reimbursement and physician contracting.  Communicates new developments that affect specific departments and/or the Enterprise.

• Partners with operational leaders to develop, maintain and direct implementation of policies and procedures related to compliance and ethical conduct within areas of responsibility. 

• Works with the senior members of the Compliance Program, Legal Services, and operational leadership to identify, research, define and resolve system-wide compliance issues. Analyzes root causes and trends and facilitates process improvement to prevent recurrence. 

• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale. 

• Responsible for understanding and adhering to the organization's Code of Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business. 

Licensure, Registration and/or Certification Required:  

• Health Care Compliance (CHC) certification issued by the Compliance Certification Board (CCB)    

Education Required:  

• Bachelor's Degree in Health Care Administration, or related field.  

Experience Required:   

• Typically requires 10 years of experience in corporate compliance within a complex environment.  Typically requires three years of experience in managing and leading compliance activities and large-scale projects.  

Knowledge, Skills & Abilities Required:  

• Demonstrated ability to lead diverse work teams in a complex matrix management structure.   

• Advanced knowledge of federal and multiple state health care regulations related to areas of responsibility, and the ability to research and analyze regulations to determine appropriate action in applying them to operational procedures and practices.   

• Demonstrated ability to manage sensitive and/or complex interactions with physicians, leaders, internal and outside legal counsel and regulatory agencies.   

• Knowledge of risk analysis and risk management principles.   

• Excellent organizational and prioritization skills, including expertise in leading multiple large projects simultaneously.  

• Skills in developing sound proposals and in implementing a comprehensive program.  

• Excellent written and verbal communication skills, including the ability to effectively communicate with all levels of team members and leadership and to address difficult and controversial issues.  

• Strong planning, problem-solving and change management skills.  

• Demonstrated ability to function as a mentor, role model and teacher.  

• Demonstrated ability to take initiative and work collaboratively with others.  

• Proficiency in Microsoft Office Suite software.