Regional Compliance Manager

PRIMARY FUNCTION

The Regional Compliance Manager is responsible for the administration of the Pediatric Associates Compliance Program to ensure compliance with company’s policies and procedures, federal and state regulatory requirements in accordance with the seven elements in their assigned region. The Regional Compliance Manager is responsible for the ongoing activities of internal auditing and monitoring programs to prevent, detect, and correct compliance risks related issues along with employee education and awareness of the Compliance Program.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all the duties that may be assigned.

1. Assist the Director of Compliance in the development and execution of the Company’s Compliance Program to ensure compliance with applicable laws and regulatory requirements.

1. Assist in development and implementation of internal audit plans with monitoring of compliance related activities to include but not limited to billing, coding, documentation of healthcare services.

1. Responsible for the effectiveness of the Compliance Program through ongoing daily auditing, monitoring, and education of compliance related activities to include HIPAA, privacy, limitations, and disclosures, outside activities, and other related compliance matters.

1. Responsible for the management of privacy patient monitoring controls to protect and detect inappropriate activities, user accessing to maintain patient confidentiality.

1. Responsible for investigating, track and trend HIPAA and privacy breaches with proper notification and reporting as required by Office for Civil Rights.

1. Responsible for drafting, updating, implementing compliance related policies.

1. Responsible for ensuring internal compliance controls are adequate and collaborating with key stakeholders to ensure best practices are in place.

1. Responsible to investigate, analyze, respond, and trend all compliance hotline calls received, all reported and identified compliance concerns with oversight on any applicable corrective action plans with updates to leadership.

1. Responsible to develop, lead, and report to leadership updates on the Compliance Program key performance indicators, goals, and strategies.

1. Serve as a subject-matter expert on compliance topics, maintains a comprehensive knowledge of applicable laws, regulations, and policies and responsible to analyze and disseminate any proposed or enacted legislation or state regulation that may impact the Company.

1. Provides new hire and focused in-service employee compliance related education.

1. Responsible for and in collaboration with key stakeholders to ensure all compliance related required training is completed as per company policy.

1. Responsible for the management of the outside activities and vendor exclusions verification database and approval processes.

1. Collaborate with departmental stakeholders to develop formal corrective actions to compliance related issues.

1. Responsible for preparing and reporting activities to the Director of Compliance for Compliance Committee reporting.

1. Assist with other duties and projects as needed.

QUALIFICATIONS

EDUCATION:

• Bachelor’s degree in healthcare related field required and master’s degree preferred.

• Years of related experience can be used to commensurate education.

EXPERIENCE:

• A minimum of 5 years of compliance experience required, and 5 years of healthcare related experience preferred.

LICENSURE / CERTIFICATION:

• CHC, CHPC preferred and/or required within a minimum of 2 years of employment.

KNOWLEDGE, SKILLS, AND ABILITIES

• Strong critical thinking skills & detail oriented

• Strong leadership presence with effective written and communication skills

• Administrative skills include the ability to develop employee training and presentations, time management, data trending and analysis.

• Ability to multi-task

• Strong computer skills; Microsoft Power Point, Excel, and other software programs

• Knowledge of healthcare terminology and principles

• Able to lead and work in a team.

• Self-directed, self-starter, organized, and capable of handling multiple projects.

• Strong analytical and problem-solving skills with great attention to detail

• ability to prioritize tasks.

• Advance level of proficiency in Microsoft Office applications including Word, PowerPoint, Excel, Vizio and other windows applications

• Flexibility and ability to effectively perform in a fast-paced environment, and responsive to multiple requests with a strong sense of urgency.

• Excellent interpersonal skills and ability to interact effectively with all tenure levels and across departments and business units.

• Highly dependable, professional integrity, good judgment, and respect for confidentiality

TYPICAL WORKING CONDITIONS

• May rotate working in the office and remote/telework.

• May involve high and frequent meetings, calls, and email volume.

• Travel locally up to 30%; may be required to travel nationally up to 10%.

OTHER PHYSICAL REQUIREMENTS

• Vision

• Sense of sound

• Sense of touch

PERFORMANCE REQUIREMENTS

High integrity, professional, and able to effectuate change in a fast-growing organization to lead the Company’s efforts to prevent, detect, monitor, correct, and educate on compliance related matters.

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to be an accurate reflection of the general nature of level of the job.