Working under the direction of the Compliance & Privacy Officer adheres with KP Compliance Framework, fosters comprehensive compliance projects through a series of activities to comply with all applicable regulations & statutes. Provides professional/technical guidance to team member and employees at large & presents complex information throughout the organization. Impacts the achievement of key functional &/or KP objectives that have direct & significant business impact. Contributes to the development of the department's objectives & annual risk assessments, work & audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Mgmt/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis. Responsible for strategic projects that set & define the direction of the compliance organization.
Essential Functions:
- Project Planning: Manages the identification of compliance accountabilities for local/regional compliance programs & internal & external resources
- Develops & executes annual compliance work & audit plans
- Strategically sets Compliance goals, timelines approaches & strategies in support of organizational initiatives
- Develops strategy & leads compliance related committees/work groups & manages external relations
- Investigations: Strategizes & collaborates when directing the administration of investigation processes & activities
- Sets strategy in efforts to identify potential compliance issues & requirements and for the creation & revision of compliance standards, policies, & procedures
- Establishes framework for monitoring of compliance adherence & reporting on compliance efforts & programs
- Acts as an independent review & evaluation body to ensure that compliance issues/concerns w/in the organization & across entities are being appropriately evaluated, assessed & maintained
- Collaborates across entities in response to alleged violations of rules, regulations, policies, procedures, & standards
- Validation: Oversees the administration of compliance programs, content, design & implementation of risk assessments &/or audits
- Manages compliance risks & develops related Corrective Action Plans, assesses completion rates & operational sustainability
- Determines impacts of implementation of new regulations & statutes & required notifications, changes, & training
- Engages external regulatory & legislative bodies & trade associations on developing regulations & laws, providing input & representing KP's interests
- Implementation: Influences & manages staff to ensure compliance & reporting on compliance efforts & programs
- Identifies & implements OIG compliance requirements
- Leads the identification of compliance requirements & sets direction for related analyses
- Develops framework & strategies in the creation, revision & development of compliance standards, regulatory compliance, & policies & procedures - not limited to privacy & security, fraud, waste & abuse, non-retaliation, disciplinary action, vendor relations etc across all levels of the organization
- Program Mgmt: Leads change mgmt efforts in service areas as well as larger departmental goals or objectives
- Identifies & acts upon opportunities to leverage direct reporting team in change mgmt activities; ensures direct reporting team is engaged in change mgmt as appropriate
- Leads issue mgmt, response, & mitigation across service areas/entities
- Facilitates communications, manages relationships w/ stakeholders, & negotiates agreement from involved parties for compliance initiatives & programs across all levels & Regions of the organization/entities
Qualifications:
Basic Qualifications:
- Twelve (12) + years of heath care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience
- Experienced in developing advanced compliance principles, theories, and concepts
- Experienced in providing framework for drafting and revising documents including policies, standards, analyses, and reports
- Focused experience in any of these areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing, clinical disciplines preferred
- Master's degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field
- Certified in Healthcare Compliance (CHC) or other accredited compliance certified, preferred
- If applicant does not have the CHC, then must complete within 12 calendar months of hire
- Expert knowledge of health care industry practices and standards
- Demonstrated leadership skills
- Expert knowledge of health care and related compliance issues and health care industry practices and standards
- Advanced knowledge of Federal and State program requirements
- Advanced/Expert knowledge of Federal reimbursement requirements
- Expert knowledge of health care compliance policies, practices and systems preferred
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.