Compliance Program Manager

CAREER OPPORTUNITY OFFERING: 

The Compliance Program Manager assists, coordinates, and manages the Ensemble Corporate Compliance Program activities/projects in collaboration with the Compliance team and under the ultimate direction of the Chief Compliance Officer. The Manager provides Compliance Program assistance to service lines to address questions, investigate compliance concerns, and follow up on corrective action plans. The Manager maintains working knowledge of Government and Non-Government payers regulations & revenue cycle operations. Manager supports the Compliance Program and operational departments to ensure compliance with OIG, CMS, and other federal, state and local regulations. 

Competencies: 

Valuing Differences - Works effectively with individuals of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds; seeks out and uses unique abilities, insights, and ideas. Considers the collective. 

Collaboration - Works cooperatively within teams and partners with others, both internally and externally as needed, to achieve success; focuses on the results of the team, not the achievements of one person.  It’s “All for One and One for All”. 

Accountability - Accepts personal responsibility and/or consequences of failure and successes, delivering on commitments and refocusing effort when needed. Someone who is willing to step up and own it. 

Time Management - Effectively manages personal time and resources to ensure that work is completed efficiently. 

Developing Trust - Gains others’ confidence by acting with integrity and following through on commitments; treats others and their ideas with respect and supports them in the face of challenges. 

Takes Initiative - Takes prompt action to accomplish goals and achieve results beyond what is required; is proactive and pursues relentlessly. 

Responsibilities:    

•  Participate in the ongoing development of the Compliance Program. 

• Work cooperatively with Company Leaders to ensure continuing support and understanding of all compliance responsibilities.    

• Monitor, review, and maintain in-depth knowledge of applicable compliance and regulatory updates, government and payer coding audits, investigations, and settlements and provide direction and guidance to organizational leaders.   

• Develop and perform training associated with Compliance Program policies, regulatory updates, government and payer coding audits, investigations, and settlements Analyze, research, and respond to questions relating to the compliance program and applicable laws, rules, and regulations.  

• Collaborate with CCO, AVP and Director of Compliance with development of Compliance Program policies and procedures. Assist in the company-wide policy and procedure process.   

• Assist with annual risk assessment and development of annual compliance work plan.   

• Assist with audits to assess compliance with policies and execution on internal controls.   

• Assist with oversight of external auditors utilized to conduct compliance audits.   

• Monitor and follow up on quarterly compliance work plan reports and control validation.   

• Evaluate compliance concerns and reports of suspected misconduct and perform investigations to ensure that all suspected violations of the Compliance Program are fully investigated and resolved.   

• Take, research as needed, and respond to day to day compliance questions.  

• Perform investigations, determine instances of non-compliance, for reported compliance concerns within framework of Compliance Investigations policy.    

• Develop and monitor corrective action plans. 

• Prepare and provide reports of activities as requested by Compliance Leadership. 

Experience We Love:  

• 3 to 5 Years previous experience 

• Demonstrated working knowledge of Revenue Cycle services, processes, HIPAA, the False Claims Act, as well as extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) Compliance Program Guidance, Department of Justice Compliance Program expectations, United States Sentencing Guidelines for Corporations, and Centers for Medicare and Medicaid Services (CMS) rules, regulations, and compliance guidance. 

• Epic, Cerner, Meditech, etc. solution knowledge preferable. 

Minimum Education:   

• Bachelors Degree or Equivalent Experience 

Required Certifications:  

• CHC (Certified in Healthcare Compliance) 

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