Vice President of Compliance

Position Summary:

The Vice President, Compliance implements, maintains and communicates effective healthcare compliance and privacy program at the assigned Prospect affiliated facility/entity. Provides ongoing support, coaching, education and participates collaboratively with management and staff to design systems and processes to assist in addressing and preventing potential compliance issues. Coordinates with Administration, Finance, Legal, Business Development, IT, Human Resources and other departments regarding Compliance efforts. Supports Prospect’s mission to attain excellence in the provision of healthcare services by consistently fulfilling the commitment to quality by compassionately and skillfully delivering patient-centered service. Reports to the PMH Chief Compliance and Privacy Officer.

Essential Job Functions:

The essential functions below are not intended to be an exhaustive list of all duties that may be assigned to this position, nor does it restrict the duties which may be assigned to this position if such duties reasonably relate to the position.

• Develops, implements and maintains an effective healthcare compliance and privacy program at the assigned facility/entity, which includes HIPAA privacy, conflict of interest, coding, documentation and billing, fraud and abuse, among other areas. Assists in the development of short- and long-term strategies. Provides support to PMH Chief Compliance Officer. Demonstrates problem-solving, critical thinking, and prioritization of work to resolve issues as they arise in an appropriate and timely manner.

• Educates workforce and others on applicable laws and regulations relating to the Compliance program and healthcare compliance and privacy risk areas, including new employee orientation and recurring training for employees and specialized training as needed. Provides ongoing support, coaching, education and participates collaboratively with management and staff to design systems and processes to assist in addressing and preventing potential compliance and privacy issues. Disseminates and interprets applicable laws, regulations, rules, policies, and procedures. Serves as a resource for healthcare compliance and privacy training materials.

• Develops, reviews revises, communicates and implements appropriate policies regarding healthcare compliance and privacy. Establishes, implements modifies and revises compliance and privacy standards, procedures and systems to improve healthcare workforce compliance and to identify the standards to which employees will be held accountable.

• Conducts regular risk assessments to identify potential areas of risk. Designs and conducts monitoring and other quality assurance periodic reviews to determine level of healthcare and privacy compliance. Coordinates with other areas of the organization to identify and address risk areas and activities.

• Conducts or oversees investigations and/or audits relating to healthcare compliance and privacy and oversees implementation of corrective action, as appropriate. Maintains an anonymous reporting mechanism and other open lines of communication for employees and other stakeholders to inquire or report suspected violations of the compliance program, policies and procedures or other laws and regulations.

• Oversees the process to identify any individuals or entities convicted of a federal health care offense or excluded from participation in federal or other health care programs and to remove such individuals as necessary. Monitors physician arrangements to ensure compliance with fraud and abuse regulations and PMH policies. Supports compliance with all applicable privacy and confidentiality laws and regulations. Supports the conflict of interest disclosure and management process.

• Utilizes data and relevant literature to identify trends to be evaluated and incorporated into the Compliance Programs risk-based monitoring. Closely monitors all government communications specific to new risk areas, government audit activity/advisories, and regulatory updates. Maintains current with and ensures healthcare compliance with applicable local, state, federal laws, regulations, and policies. Keeps abreast of changes in laws and regulations.

Core Organizational Values:

We are a coordinated network of hospitals, affiliated medical groups and ancillary health care services working for the benefit of every person who relies on and trusts us for care. Our comprehensive networks aim to provide coordinated, personalized care. Through our affiliated networks, we strive to provide a healing environment and quality care by demonstrating the following organizational core values:

• ACCOUNTABILITY: We honor our commitments and focus on “how it can be done”.
• EXCELLENCE: We are committed to the highest quality and safety standards.
• COMPASSION: We understand and reflect the diverse communities we serve.
• INTEGRITY: We are down-to-earth, honest and approachable.
• TEAM PLAYER: We recognize trusting relationships and strong teams are key to achieving success.
• ENTREPRENEURIAL: We come up with new ideas to solving problems/issues, and embrace and adapt to change.
• CONSTRUCTIVE CONFRONTATION: We give and receive direct feedback in a group setting; unafraid of confrontation
• GOAL ORIENTED/HARD WORKER: We set and achieve goals with a sense of urgency and do not give up until met.
  
• PHYSICIAN/CUSTOMER-ORIENTED: We seek to understand physician/customer needs and identify with their realities

Required Qualifications:

• Eight (8) years of directly related professional and/or managerial experience in healthcare compliance
• Masters Degree
• Thorough knowledge of applicable federal, state and local laws, regulations and policies
• Excellent interpersonal skills to deal effectively and tactfully with people at all levels
• Demonstrated ability to communicate effectively, both verbally and in writing
• Ability to effectively present information and respond to questions from managers, employees, etc.
• Ability to build effective relationships internally and externally to support the company’s business objectives
• Exceptional planning, organizational, and change management skills
• Exceptional analytical, reasoning, judgment and problem-solving abilities and planning skills
• Computer Literacy and Proficiency required in Microsoft Office Suite: Word, Excel, PowerPoint

Preferred Qualifications:

• Juris Doctor
• CPC, CHC, CPA, CIA or similar professional credential

Physical Requirements:

Indicate physical requirements for performing the essential functions of the job by double clicking and selecting ‘checked’ on the boxes below. These are requirements normally expected to perform regular job duties. Reasonable accommodations may be made in compliance with the Americans with Disabilities Act of 1990, and applicable, state and local law, to enable individuals with disabilities to perform the essential functions. Incumbent must be able to successfully perform all of the essential functions of the job with or without reasonable accommodation.