What are the responsibilities and job description for the Advisor, Population Health Compliance position at Ohio Health?
We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.
Summary:
The Compliance Advisor provides direction and oversight with respect to the compliance activities for OhioHealth's Population Health Services (PHS) which includes the OhioHealth Clinically Integrated Network (CIN), OhioHealth Venture Accountable Care Organization, CMS Shared Savings Program, the Value Services Organization (VSO), Medicare Advantage Contracts, Commercial Contracts, CMS Bundled Payments for Care Improvement Advanced, and other population health programs as they arise. The Compliance Advisor is responsible for:
- Identifying and assessing areas of compliance risk and participating in the annual Ethics & Compliance Program Risk Assessment.
- Collaborating with stakeholders to effectively incorporate the PHS compliance needs within the system operations and programs
- Monitoring compliance with payer (Commercial, Medicaid, Medicare, Medicare Advantage) contracts, and regulatory requirements
- Working with stakeholders to design and implement processes for stakeholders to track & audit services provided to the CIN by the VSO which includes monitoring CIN quality, and VSO time
- Auditing VSO's compliance with Clinical Integration requirements
- Working with stakeholders to develop bylaws, policies and procedures around network management and processes to store confidential data (ie. Provider Scorecard info, Provider Information- Agreements, etc)
- Developing and implementing compliance education for PHS as appropriate
- Managing incident response and open lines of communication for PHS as appropriate including the ACO's anonymous reporting mechanism
- Other compliance duties as assigned
Minimum Qualifications:
Bachelor's Degree (Required)CFE - Certified Fraud Examiner - Association of Certified Fraud Examiners, CHC - Certified in HealthCare Compliance - HCCA Health Care Compliance Association
SPECIALIZED KNOWLEDGE
Experience with federal and/or state regulations and compliance oversight in health care. The ability to comprehend and interpret regulatory, legislative, and contractual mandates.
1-5 years' of experience in health care compliance.
Work Shift:
Day
Scheduled Weekly Hours :
40
Department
COO
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment