Compliance Program Manager

Overview

Talent Pool - Administration & ClericalUnder minimal supervision, the Compliance Program Manager is responsible for communicating, driving, and proactively monitoring compliance with all applicable federal and state laws, regulations, policy directives and ethical requirements for Cone Health facilities including, but not limited to, the hospitals, cancer centers, hospital based clinics, and ancillary services. This position provides direction, management and leadership in the administration of the Cone Health Compliance program at the direction of leadership. This may include development of policies, education, communications, and the establishment and maintenance of processes to determine Cone Health's compliance with its policies and industry regulations. The Compliance Program Manager also performs compliance assessments, assists with the creation and on-going management of the annual workplan, provides subject matter guidance on compliance topics for business units and operations of Cone Health facilities. The Compliance Program Manager also assists the leadership in developing compliance policies, procedures, and best practices, and strive to position the compliance function as a key partner in ensuring the success of Cone Health's mission, values, and strategic initiatives. This position works with executives, operations leaders, external government agencies and parties as well as legal counsel when appropriate.

 

Responsibilities

 

 

• Assist in management of the day-to-day operations of the Compliance Program at the direction of leadership. Lead compliance initiatives and provide direction to drive results and ensure projects are completed and communicated on time.
• Supports the development and use of data analysis tools to conduct compliance monitoring and help develop metrics to track the overall effectiveness of the compliance program.
• Perform compliance monitoring and auditing activities of high-risks areas.
• Support the development of educational programs (annual required training and ongoing training) on compliance for employees, managers and senior leaders.
• Manage the Compliance Helpline including investigation, remediation and corrective action as needed; Manage the case management process, including monitoring and documenting the investigation and resolution of complaints. Conduct investigations of reports or evidence of non-compliance
• Oversee and manage monthly sanction screening process for all team members, board members, volunteers, providers, vendors, and other groups as deemed necessary.
• Provide technical and regulatory guidance to all departments on compliance matters to ensure compliance with applicable regulations and standards.
• Support the response to external audits and activities for Cone Health and its healthcare services.
• Assist in developing, implementing, evaluating, and updating compliance policies and procedures and the Compliance and Audit Services work plans.
• Manage and oversee the enterprise conflicts of interest policy implementation and annual questionnaire and follow-up process.
• Participate in workgroups and provide advisement related to compliance with applicable regulatory, contractual, internal or other requirements.
• Conduct research into new and revised regulations applicable to the organization's operations and provides recommendations to leadership regarding potential implementation.

Qualifications

 

EDUCATION:Required: Bachelor's Degree in business, health care administration, or a related field.

 

EXPERIENCE:Required: 3-5 years or more of healthcare compliance experience. Familiarity with healthcare laws and regulations.Preferred: Experience conducting compliance audits, billing, coding, EPIC, hotline management and compliance data analysis tools and techniques. Experience leading a team.

 

LICENSURE/CERTIFICATION/REGISTRY/LISTING:REQUIREDDrivers License | Valid Drivers LicenseApproved Compliance and/or Coding certification within 18 months of hire. PREFERREDCertified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP) preferred.Certified Professional Coder or Certified Coding Specialist certification is a plus.