Please note: Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is an affiliated company of Texas Health and UT Southwestern. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health or UT Southwestern employee.
Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Director Compliance.
The Compliance Director, is responsible for designing, implementing, training, investigating, monitoring, and enforcing, when necessary, programs, policies, and practices to ensure that all applicable departments are in compliance with and maintains compliance with federal, state, and local regulatory requirements, tracks laws and regulations that might affect the organization's policies and procedures, and prepares compliance related reports to present to senior management. The Compliance Director is responsible for designing, implementing, training, investigating, monitoring, and enforcing, when necessary, programs, policies, and practices related to the SWHR-CIN HIPAA Privacy Program. The Compliance Director is responsible for compliance activities of SWHR-CIN and its related entities and will assist and participate in activities for other SWHR-CIN entities as directed by the SWHR-CIN Chief Compliance Officer.
Salary range is Min. $94,536/year to Max. $145,288/year – based on relevant experience
Location: Farmers Branch, TX
• Full time, day shift
MANAGEMENT AND OVERSIGHT COMPLIANCE PROGRAMS:
Oversight, maintaining the effectiveness of the Compliance Program core processes
Carry out the SWHR-CIN annual Conflicts of Interest disclosure questionnaire process.
Carry out the periodic risk assessment process, evaluate results to identify high risk areas.
Assist SWHR-CIN Chief Compliance Officer with formulation of entity level compliance and privacy work plans focused on continuous improvement of processes in identified risk areas.
Oversee the employee, vendor, and contractor screening processes that prohibit employment or contracting with individuals or companies exclude from federally funded programs.
Assist the SWHR-CIN Chief Compliance Officer with preparing for meetings by developing agendas, minutes, and resource materials, where compliance information may be reported, as needed.
Oversee the operation of the SWHR-CIN Compliance Hotline including policies, procedures and protocols; data analysis; development of reports; etc., including taking calls and performing follow-ups, as appropriate.
Produce reports as requested by the SWHR-CIN Chief Compliance Officer.
MONITORING, AUDITING AND ENFORCEMENT:
Oversee entity compliance monitoring and auditing activities and coordinate as needed
Communicate audit/monitoring findings.
Monitor the day-to-day activities of the SWHR-CIN entities to further its HIPAA privacy and compliance objectives.
Conduct and oversee investigations as appropriate. Coordinate investigations with legal counsel and SWHR-CIN Chief Compliance Officer for major violations of law or policy. Coordinate, as necessary, with the Chief Information Security Officer on HIPAA privacy/security related investigations.
Oversee and follow-up, as applicable, implement corrective actions to investigations and other issues generated by the Compliance Program.
Oversee and carryout independent investigation on matters related to compliance and/or response to reports of possible compliance issues. See that matters are resolved, and corrective action taken as warranted keeping the SWHR-CIN Chief Compliance Officer informed as appropriate.
Coordinate with the SWHR-CIN Chief Compliance Officer and Legal Services on any review or investigation that is non-routine and/or appears to create risk for SWHR-CIN.
See that corrective action is taken in response to substantiated reports of violations or errors.
Develop, coordinate and oversee annual internal compliance review and monitoring work plan including processes and controls to provide compliance with legal requirements and SWHR-CIN standards.
Coordinate external audits such as recovery audit contractors for governmental agencies and/or commercial payer audits.
Analyze data, implement benchmarking and publish dashboards for key compliance and HIPAA privacy risk areas.
PROGRAM COMMUNICATION AND TRAINING:
Communicate the importance of compliance and Compliance Program to senior management, the entity compliance committee, and employees.
Increase knowledge of the relationship between services provided to patients, medical record documentation, reimbursement, and audit liability, and other pertinent compliance topics.
Lead staff in coordination of efforts pertaining to audits and/or compliance-related matters and topics.
Motivate staff to use a variety of mediums and facilitate an atmosphere of teamwork and common goal achievement.
Develop and coordinate multifaceted educational and training programs for SWHR-CIN and employees that focus on the elements of compliance and seek to ensure that employees and management are knowledgeable of and comply with federal and state laws and regulations including Medicare/Medicaid program requirements.
See that proactive SWHR-CIN provider education is provided in response to identified risk areas such as coding, billing, and documentation specific to SWHR-CIN lines of business.
Develop effective lines of communication and awareness within SWHR-CIN of the Compliance Programs.
POLICIES, PROCEDURES, AND STANDARDS:
Assisting with the development, implementation, and maintenance of policies and procedures that address specific risk areas to the SWHR-CIN’s Compliance and Privacy Programs.
Oversee the application of SWHR-CIN System Compliance and Privacy policies for the Compliance and Privacy Program.
Creation and revision of Compliance and Privacy Program policies under the direction of the SWHR-CIN Chief Compliance Officer in accordance with the seven recognized elements of an effective Compliance and Privacy Program.
Report on a regular basis to the SWHR-CIN Chief Compliance Officer on Program effectiveness including progress and efforts to reduce vulnerability to compliance and privacy risks.
Continually improve SWHR-CIN programs in light of organization needs and consistent with laws and regulations that impact SWHR-CIN business operations.
INVESTIGATE AND RESOLVE QUESTIONS/CONCERNS:
Facilitate internal reporting processes including the Compliance Hotline and open lines of communication for reporting of questions or concerns by employees, contractors, patients or others.
The ideal candidate will possess the following qualifications
Bachelor's Degree in Healthcare administration, health information management, public health, health policy, business administration, or related field required.
•*Master's Degree Healthcare administration, health information management, public health, health policy, business administration, health law, or related field preferred.
7 years Managed Care compliance is required
Demonstrated organization, facilitation, written and oral communication and presentation skills.
High degree of interpersonal skills, influence, negotiations and problem-solving abilities and excellent communication skills.
Ability to work cross functionally and collaborate with other departments and organizations on compliance matters.
Proficiency in Microsoft Office suite.
Must be able to frequently problem solve, make decisions, interpret data, organize and analyze work flow, write, plan, and use simple arithmetic.
Must be able to operate general office equipment including but not limited to: computer, phones, and related media and information devices.
Must have the ability to communicate in writing, speaking, and hearing, both in person and/or by telephone.
Ability to manage and train others.
- Location: Farmers Branch, Texas, United States
- Shift: Day Job
- Schedule: Full-time
- Pay Basis: Hourly
- Minimum Salary:
US Dollar (USD)
- Market Salary: US Dollar (USD): 55.70
- Maximum Salary :
US Dollar (USD)