Job Description

General Summary

• Supports the Compliance Program and is committed to the operation of an effective compliance program.
• Works under general direction to perform ongoing activities related to the development, implementation, and maintenance of and adherence to policies and procedures in compliance with federal, state, and local laws, and regulations.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

• Oversees and implement the corporate compliance program, increases conformance with applicable laws, regulations, and accreditation standards which may include the University of Maryland Medical System’s (UMMS’) compliance with the requirements of Federal health care programs such as Health Information Portability and Accountability Act (HIPAA), Anti-kickback / Stark, Medicare billing, and clinical research.
• Provides guidance to departmental representatives with development of policies specific to their departmental needs. Draft compliance policies and procedures as directed.
• Develops monitoring and auditing tools. Provides summary reports to promote compliance and privacy. Oversees self-monitoring results from the different areas to ensure that programs and procedures are in compliance with regulatory requirements.
• Coordinates compliance auditing and monitoring activities. Performs and reviews, as needed, for compliance with various regulatory guidelines. Collects data and updates compliance monitoring reports.
• For internal audit compliance-related findings works with departments to ensure completion of management action plans on a timely basis.
• Provides ongoing education and compliance training of staff; includes regular training sessions and special topic training as required.
• Promotes activities to foster compliance and privacy awareness through various modes of publicity (publications, newsletters, fairs, Intranet, etc.).
• Maintains the system to solicit, evaluate and respond to complaints, problems and issues through all means of communication. Coordinates and oversees investigations, responses to violations and corrective actions for reports of alleged fraud and noncompliance.
• Investigate compliance concerns and summarize findings and recommendations for future action.
• Collaborates with Member Organizations to develop and implement investigation processes and policies. Ensures case investigators adhere to set procedures for complaint or case handling.
• Oversees the escalating of complaints and/or cases to ensure proper resolution.
• Reviews and evaluates investigation reports to make proper adjustment necessary for achieving set objectives.
• Utilizes IT systems/tools in managing and coordinating data investigation.
• Drafts committee agendas and materials. Attends meetings and supports UMMS and Member Organizations’ Compliance Committees. Serve as the compliance representative on relevant Member Organization committees, includes participation, providing reports, sample policies/procedures, etc.
• Monitors and keeps up-to-date with laws, regulations, standards and guidelines. Communicates and distributes information relating to the updates to the appropriate managers and executive.
• Prepares reports to meet the needs of the Chief Compliance Officer, Vice President of Compliance Operations, Director of Compliance, UMMS Executive Management, and the Audit and Compliance Committee of the Board of Directors.
• Mentor and guides Compliance Analysts.
• Consults on an ongoing basis on related issues with operation managers and executives.
• Collaborate with management and leadership staff to identify concerns and potential solutions.
• Perform other duties as assigned.

Qualifications

Education and Experience

• Bachelor’s degree or an equivalent combination of education and experience is required. Master’s degree preferred.
• Two ( 2 ) years of related compliance experience with a background in healthcare regulatory issues, including general familiarly with hospital billing, is required. Four (4) years of experience in healthcare or regulatory fields is preferred.
• Certified in Healthcare Compliance or other professional compliance certification (or achieve certification no later than 12 months from hire date.)
• Experience and working knowledge of Corporate Compliance, Audit, Legal, Privacy, or Information Security. Experience with case investigations management and compliance hotline management preferred.

Knowledge, Skills and Abilities

• Current knowledge of healthcare regulatory and compliance issues. Proven organizational skills and administrative ability is required.
• Highly effective verbal and written communication skills are necessary to communicate and work effectively with all levels of staff and management.
• Knowledge and ability to understand procedures, practices and policies in the assigned department and for the medical system.
• Flexibility and the ability to adapt to shifting priorities, to work independently as we as part of a team. Must be self-motivated an able to evaluate the scope of each day’s work and use time management and organizational skills to accomplish assignment.
• Knowledge of personal computer operation and Microsoft Office applications. Experience with governance, risk, and compliance (GRC), audit, compliance, or other business intelligence based software preferred.
• Ability to gather and analyze data and reports. Must have strong analytical and problem solving skills.
• Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence.
• Must be able to maintain confidentiality of all compliance related or other reported issues.

Additional Information