Description
Medical Compliance Officer
Requisition Number 1811381
Your Role :
The Office of Healthcare Compliance is seeking a Hospital Compliance Officer , experienced in the broad range of contracting, processes, systems, documentation and billing regulatory issues that may present to a (271) bed free-standing, specialty children's hospital within an academic medical, tertiary care and Level 1 trauma center (MCJCHV). In this pivotal role, you will report to the medical system compliance office, but will work directly with the hospital leadership teams to prevent and detect potential regulatory compliance problems while partnering with that leadership to increase overall efficiency and effectiveness of clinical, financial and administrative operations.
You will work with the Compliance Office to ensure that the Institution implements and maintains an effective compliance program that includes:
- Written standards of conduct and policy
- A dedicated Compliance Officer and oversight Committee
- Regular training of employees
- A process to receive complaints
- Audits to monitor compliance
- Investigate process for identified concerns
- Enforcement of standards and remedy of validated allegations
You will be responsible for the oversight of and guidance related to federal and state regulatory and payment requirements and private contracting issues relevant to the prevention and/or detection of fraud, waste and abuse by MCJCHV and its employees and agents.
Key Responsibilities :
- Consultation. Represent the compliance function in advice to hospital leadership and process improvement analysis
- Knowledge. Maintain extensive and current knowledge of health care compliance in the areas of hospital contracting, processes, systems, documentation and billing
- Policy Development. Coordinate groups and functions to develop and maintain effective and clear policy and procedure applicable throughout MCJCHV
- Internal Controls. Review and recommend controls and processes implemented by personnel and systems to verify appropriate operations
- Inquiries. Lead investigations into allegations of errors or process improprieties at MCJCHV
- Liaison. Serve as a liaison between external regulatory auditors and reviewers and MCJCHV
- Collaboration. Facilitate communication between MCJCHV personnel and other functions of the Compliance Office, such as education and auditing & monitoring, to minimize regulatory risk and maximize clinical, financial and administrative efficiency
A day in the life of this role may include :
- Providing compliance advice and guidance to hospital leadership.
- Supporting the development and implementation of processes to strengthen internal controls.
- Collaborating with hospital departments to direct compliance initiatives and process improvement controls.
- Monitoring and researching applicable state and federal regulations and defined compliance policies and procedures to ensure that operational activities meet federal and state requirements.
- Overseeing and maintaining MCJCHV's compliance program to include annual compliance policy and procedure review.
- Coordinating internal control and compliance reviews including risk assessments of compliance areas, assessing the adequacy of functional compliance policies and procedures, and reporting the results to MCJCHV leadership.
- Responding to and investigating allegations of violations of the compliance program at MCJCHV.
- Reporting to Chief Compliance Officer and participate in system wide compliance initiatives.
Requirements :
- Advanced degree (MBA, MHA, JD, or related) is preferred. Certification in health care compliance is required.
- 5+ years of experience in health care compliance. Previous hospital experience highly desirable.
- Experience with a non-profit academic medical center or other organization of similar complexity is preferred.
- In-depth knowledge of the Federal and State laws and regulations governing health care.
- Demonstrated experience in internal audit principles and practices. Knowledgeable of Medicare, Medicaid, and commercial payor enrollment and billing requirements.
- Experience in analysis and in advising on regulatory requirements.
- Experience as liaison and in coordinating activities between departments and functions and with various regulatory agencies.
- Competency with Microsoft products (Project, Access, Visio, PowerPoint, Outlook, Excel, Word), web technologies and database tools, and willingness to learn new technologies when presented.
Department Summary:
| The Office of Healthcare Compliance manages VUMC's compliance program. Our office mission is to ensure and promote the highest standards of business ethics. VUMC is committed to complying with all federal and state laws, rules, and regulations. Specifically, our office is tasked with: - Preventing any accidental or intentional violations of law
- Detecting violations if they occur
- Immediately taking corrective measures if violations occur
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For more information, please visit: https://ww2.mc.vanderbilt.edu/DCCI/
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