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Manager Privacy & Compliance

Company: Capital Health
Location: Trenton
Posted on: May 28, 2023

Job Description:


Position: 12923

Serves as an expert in identifying, assessing, and investigating professional patient billing compliance and privacy risk by maintaining up-to-date knowledge of rules, regulations, authoritative guidance, and standards related to Capital Health's major billing and privacy compliance risks. Supports the Compliance Office's function as an independent appraiser by carrying out timely and accurate audits and investigations for provider and practice based audit issues. Administers good judgement and decision making skills in regards to the department. Provides oversight supporting physician arrangements, including compensation review, implementation, and audit functions. Ensures communication and transparency across multiple departments and management across the organization. Complies with federal, state, and local legal requirements by studying existing and new legislation, enforcing adherence to requirements, and advising management on needed actions.

Educates stakeholders and staff and provides expertise in physician contracting procedures, compensation modeling, contract implementation, and contract review and audit. Recommends and implements work-flow processes for daily operations, evaluating and redesigning policies, procedures, and standards to ensure physician contract implementation efficiency.
Reviews and ensures contract agreements are accurate and appropriate. Assesses interdepartmental processes around contract management and provide recommendations on efficiencies and process improvement.
Coordinates all compensation arrangements to ensure they are approved and within applicable FMV standards and strategic initiative write-ups for compensation arrangements are documented and maintained. Maintains proper internal controls for all clinician payment arrangements to ensure regulatory compliance.
Coordinates contracts in accordance with Capital Health's compensation philosophy and policies and procedures. Identifies potential compliance issues and risk in contracts, assesses issues, and implements processes and controls to mitigate risk to Capital Health. Identifies Office of Inspector General Work plan compensation arrangements risk areas and to document workflow, contracts, and policies as needed.
Works directly with internal and external legal and outside valuation firm to minimize risk of clinician payment arrangements to ensure fair market value and commercial reasonableness. Ensures compensation arrangements support Capital Health's mission. Coordinates with operations and appropriate clinical leadership to identify the need for the clinical services for development of the contract for compensation arrangements.
Coordinates clinician alignment and compensation models for Capital Health initiatives and services lines. Educates stakeholders on the regulatory compliance of clinician compensation arrangements, including but not limited to Stark, Anti Kickback and appropriate laws, rules and regulations pertaining to physician arrangements. Leads and participates in appropriate committees as requested and assigned.
Audits physician contracts for appropriate implementation, goals, productivity, duties, metrics, and compensation provided on an appropriate regular basis. Leads a collaborative team approach, including Human Resources, Finance, appropriate physician and hospital stakeholders, legal and compliance with regards to physician arrangements.
Assists in the development and leads the implementation of standardized Physician and APP compensation plans across Capital Health. Manages the design and development of reports that support the Physician and APP compensation plans.
Works closely with Capital Health Finance to ensure accurate physician and APP compensation budgets and incentive accruals are submitted appropriately. Works closely with appropriate colleagues within Capital Health Medical Group, Capital Health hospital based departments, Capital Health Academic Affairs & Residency, Quality, and Patient Satisfaction to ensure appropriate metrics are established in a timely manner.
Maintains current knowledge of professional billing compliance, privacy and regulatory risks related to all Capital Health's provider service lines. Researches, identifies, reviews, and analyzes policies, regulations, authoritative guidance including billing manuals, State and Federal privacy guidance and other regulatory information for federal health care programs, current procedural terminology code descriptions, and other materials relevant to compliance risk.
Recommends to the Chief Compliance Officer and Assistant Compliance Officer audit issues for annual audit work plan and/or to comprehensively address Capital Health's risk profile. Prepares draft audit work plans as directed by the Chief Compliance Officer. Applies applicable rules to develop audit protocols, tools, and work papers to accurately assess compliance risk and to quantify compliance performance. Identifies necessary data and documentation to complete audits and obtains needed data and documentation in a timely manner. Analyzes data and documentation according to audit protocols accurately. Conducts interviews with staff, patients and others and performs on-site observations to obtain information about, and accurately assess operational processes, staff conduct, physical structures, and workflow dynamics. Prepares follow-up requests for necessary information or observations as indicated by data and information collected.
Implements the Capital Health Department Work Plan - Physician Practice process, including identifying risk areas, assessing control systems, auditing and assessing training. Makes recommendations to Chief Compliance Officer. Meets with Office Managers and Administrative Directors to kick off all Physician practice compliance assessments. Assesses compliance control systems and training programs to determine comprehensiveness and effectiveness. Prepares Physician Practice Departmental Score Cards for review and approval by Chief Compliance Officer. Provides guidance to Administrative Directors and Office Managers related to implementation of physician practice work plan. Provides compliance training to departments on an assigned basis.
Analyzes and assesses information, data, and documentation obtained during the audit process accurately. Prepares accurate draft audit reports to meet audit plan deadlines. Reviews draft audit reports with Chief Compliance Officer including on proposed findings and recommendations for corrective action. Participates in meetings to review audit findings and recommendations. Manages the physician practice audit process to ensure audit timelines and targets are met.
Works at the direction of Chief Compliance Officer and Assistant Compliance Officer to investigate potential noncompliance related to State and Federal laws governing the use and disclosure of Personally Identifiable Health Information. Conducts interviews with staff, patients and others as directed by the CCO/ACO.
Acts as a primary point of information and expertise for privacy-related policy issues within Capital Health Medical Group (CHMG), and as assigned. Supports operational management by providing guidance on the implementation of privacy policy and the reduction of privacy risk. Conducts privacy reviews throughout the system. Makes recommendations to improve controls and reduce risk based on reviews.
As to CHMG, acts as a primary point of contact for patient privacy complaints, interviewing patients, assessing concerns and assuring them of Capital's commitment to protecting privacy and security of health information. Assesses patient privacy complaints and making recommendations to the CCO/ACO for an investigation plan.
Demonstrates an ability to assess a situation from various perspectives and considers several alternatives and choose an appropriate course of action. Obtains all pertinent information to make an informed decision. Reviews and determines appropriate disposition of mail, faxes, and e-mails and responds to all requests in a timely manner. Protects the integrity and confidentiality of information at all times.
Analyzes and tracks department participation and performance in compliance self-monitoring program. Works collaboratively with professional documentation and coding department regarding physician documentation, monitoring and auditing. Reports to the Chief Compliance Officer on a regular basis concerning participation and performance in compliance self-monitoring program. Provides education and training regarding professional billing compliance to operational units as directed by Chief Compliance Officer and in collaboration with appropriate departments. Identifies information system enhancements to promote compliance.
Serves as a liaison to CHMG and other provider based departments, as assigned, by educating directors, supervisors, and staff about implementing monitoring protocols, tools, plans. Serves as a model employee for compliant behavior. Promotes compliance through positive interactions with fellow employees. Obtains information through data requests, analysis, document review, and interviews with staff as directed by Chief Compliance Officer and Assistant Compliance Officer. Takes lead responsibility for investigations as directed by Chief Compliance Officer/Assistant Compliance Officer.
Maintains work papers in a systematic and professional manner. Organizes working files in a manner to permit review and evaluation by third parties. Complies with office electronic and paper filing systems.
Performs other duties as assigned
Bachelor's degree in Healthcare, Business Administration, or related field required. Master's Degree in Healthcare, Business Administration, or related field preferred . click apply for full job details

Keywords: Capital Health, Trenton , Manager Privacy & Compliance, Executive , Trenton, New Jersey

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