This position reports directly to the Director of Compliance, Quality, and Risk. Provides direction, management, and leadership in the administration of the compliance program. Ensures that the compliance program and activities are in accordance with local, state and federal laws, rules, and regulations and best-practice compliance processes.
- Minimum of Bachelor's Degree as a Registered Nurse of Florida.
- 7 years experience of related duties and responsibilities.
- Certification in health care compliance required or ability to acquire within 1 year of hire.
- Strong interpersonal skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Skill in organizing resources and establishing priorities.
- Valid Florida Driver's license and auto insurance per Company policy.
- Able to travel to off site locations.
- Able to work with minimum supervision and exercise a high degree of discretion and independent judgment
- Ability to collaborate effectively with all levels of the organization and demonstrate ability to manage through influence.
- Able to prioritize multiple job responsibilities.
- Satisfactorily complete competency requirements for this position.
Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment Performance Improvement activities as appropriate for the position.
Leadership Success Factors:
- Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
- Initiative. Originate action to achieve goals.
- Management Identification. Identify with and accept the problems and responsibilities of management.
- Judgment. Make realistic decisions based on logical assumptions, factual information and in consideration of organizational resources.
- Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitor results.
- Leadership. Use appropriate interpersonal styles and methods in guiding others.
- Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.
- Regulatory Compliance: Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance.
- Manages the annual compliance risk assessment in identifying relevant industry/OIG, CMS and Company specific risk areas.
- Manages and/or performs audits and on-going monitoring programs corporate wide.
- Prepares compliance monitoring/auditing reports for the Corporate Director of Compliance, Quality, and Risk and Chief Compliance Officer.
- Facilitates the Compliance Committee.
- Ensures compliance findings are addressed and works with internal directors/managers to coordinate the development/implementation and revision of company policies, practices and/or processes as necessary.
- Coordinates investigations of potential violations of law or company policy under direction of Corporate Director of Compliance, Quality and Risk and Corporate Compliance Officer and legal counsel.
- Coordinates timely response to requests from Fiscal Intermediary, Carrier, and other Third Party payers.
- Develops and maintains ongoing relationships with regularly with regulatory bodies, e.g. CMS, Medicare/Medicaid, Champus/Champva, Tricare, etc.
- Coordinates activities of individuals who perform compliance and coding audits/investigations, testing/monitoring and related follow-up education and training.
- Provides documentation, coding and compliance guidance, support and education to physicians and non-physician practitioners.
- Develops and/or updates general compliance education and training programs.
- Creates and evaluates ways to measure and demonstrate the effectiveness of compliance testing and documentation and coding education activities.
- In conjunction with other areas, maintains the ethical standards and integrity of clinical, financial and operational practices which contribute to the Company's organizational effectiveness and competitiveness.
- Directly responsible for reviewing all work products and/or chart reviews related to compliance.
- In conjunction with Director of Compliance, Quality and Risk develops annual Compliance Plan and Audit Calendar.
- Conducts final review of requests for medical records from regulatory bodies prior to release of record; requires review of any financial billing data associated with particular record.
- Ensures documentation is accurate and complete and identifying any discrepancies.
- Determines corrective action plans for addressing and/or correcting documentation or billing data.
- Ensures quality control measures are in place around audits and reviews.
- Standardizes the audit and monitoring tools and/or creates and edits tools as needed.
- Monitors NHPCO, CMS and AHCA web sites for new regulations and statutes; creates and/or provides related interpretation and communiqués to Chapters Healthcare leadership.
- Serves as subject matter expert related to all hospice compliance requirements.
- Develops/reviews P&Ps, practice guidelines to ensure compliance with regulatory requirements.
- In conjunction with the Quality and Employee Health Manager, Co-Chairs the Forms Committee and other corporate committees as identified related to compliance.
Orientation and Education
- Coordinates/provides the initial orientation for all staff.
- Develops annual education; provides interim education on related topics as needed.
- Assists in providing education for all departments and services relative to Compliance.
- Interfaces with Clinical Educators to provide required education of staff related to Compliance during orientation, annually, and as needed.
- Revises internal processes and updates forms and procedures used by Compliance as needed or to keep current with regulatory requirements.
- Enhances professional expertise through attendance at national, state and local conferences.
- Participates in appropriate professional or specialty organizations through membership and attendance at local meetings.
- Participates in Compliance Department meetings at the corporate level; represents corporate compliance at the subsidiary level.
- Participates in Joint Commission and Performance Improvement task forces as needed to coordinate with compliance requirements.
- Promotes the community outreach by participating in the development of educational materials and offerings for both the public and medical community.
- Attends Interdisciplinary Groups as needed to facilitate compliance processes and programs at the operational level.
- Participates in Corporate Comprehensive Emergency Medical Plan as directed by Director of Corporate Compliance, Quality and Risk.