Job Description
Overview:
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities:
Job Summary / Purpose
The Market Director CRO, as a member of the market leadership team, promotes the highest standards of Corporate Responsibility (CRP). They are the resource and triage person for all compliance matters. They are responsible for overseeing, coordinating, monitoring and implementing the CRP for their assigned facilities. They will work collaboratively with other market and division leaders, and will assist in: identifying, implementing, monitoring and mitigating risk within the organization.
Essential Key Job Responsibilities
Serves as the compliance expert for acute care. Monitors, disseminates and provides consultation regarding federally issued guidance, pertinent new laws and regulations and/or revisions to current laws and regulations as they pertain to division compliance. Examples of these include, but are not limited to, the Federal Sentencing Guidelines, HIPAA, Physician Self-referral law and the Affordable Care Act. Such guidance, laws and regulations may come from many agencies including but not limited to: The Office of the Inspector General (OIG), Centers for Medicare and Medicaid (CMS), Department of Justice (DOJ), Internal Revenue Service (IRS), state regulatory agencies, etc.
Works closely with CommonSpirit Health legal services group and other applicable functional areas to ensure proper interpretation, dissemination and education regarding laws and regulations affecting physician business relationships.
Establishes a compliance program that supports the corporate CRP model consistently. This includes overseeing and providing status reports to leadership on; audits, standard reports, training, investigation of hotline reports through resolution including action planning and other risk mitigation efforts and board reporting if assigned.
Analyzes reports, data, trends and governmental enforcement efforts to keep management and governance informed of the current regulatory environment and the potential impact to CommonSpirit Health. Works with the SVP Division Corporate Responsibility and functional leadership to develop and assess clinical, billing and outlier risks through analysis of billing and quality data.
May supervise facility compliance staff and be responsible for hiring, performance evaluations, coaching and development.
The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.
Qualifications:
Required Education and Experience
Bachelors degree in related discipline.
Minimum of five (5) years experience in a management-level position in a hospital or healthcare system.
Minimum of five (5) years working experience in one or more areas of healthcare compliance, in either an acute care or clinic environment.
Required Licensure and Certifications
Certified in HC Compliance ( CHC ), Certified in Healthcare Privacy Compliance ( CHPC ) OR Certified in Healthcare Research Compliance ( CHRC ) preferred upon hire or required within the first year of employment.
Required Minimum Knowledge, Skills, Abilities and Training
Experience in development and implementation of facility-wide policies and/or practices.
Proven success with identifying and resolving operational issues.
Excellent problem-solving skills
Ability to:
work collaboratively with other discipline leaders to accomplish compliance goals.
use system-thinking when considering widespread effects of decisions and actions
develop and sustain cooperative working relationships with all levels of employees, physicians and customers
research complex, legal, regulatory and contractual documents for interpretive purposes
collect, organize and analyze data and information
align decisions and projects with the organizations mission and business priorities
work independently to manage multiple complex projects simultaneously
Working knowledge of:
regulations and accreditation standards, knowledge of specific state and federal requirements and standards related to healthcare industry
healthcare billing and coding compliance and healthcare program reimbursement regulations and guidance
Microsoft Office, Google Suite and similar software applications
Strength in utilization of Change management techniques
CommonSpirit Health
Job Tags
Work experience placement, Remote job,