This position plans, designs, implements and maintains a corporate compliance program including related policies, procedures and processes. Serves as a role model for ethical management behavior and promotes an awareness and understanding of high ethical standards consistent with the organizations values and federal and state legal requirements. Based on area of assigned responsibility, serves as the organizations compliance program resource and liaison in all settings, including but not limited to, community and academic hospital inpatient and outpatient care, home care, physician clinics, long term care, home medical equipment, health plans, health insurance, and ancillary services.
Directs, implements, maintains, and enforces area-wide compliance programs, including related policies, procedures and processes on a daily basis, in conjunction with organization-wide compliance efforts, as well as federal, state and local regulations, such as Medicare and Medicaid. Ensures all programs and related efforts are consistent with the organizations compliance philosophy and strategies established by the top compliance executive.
Contributes to the system-wide compliance audit function by directing related activities. This includes directing investigations and monitoring compliance activities in accordance with compliance program standards, policies and procedures. Reviews and ensures compliance with federal and state regulations imposed by government agencies and others. Advises on audit controls for internal processes ensuring appropriate measures are in place for accurate, complete and compliant programs throughout the system. Proactively identifies areas throughout Banner where there may be opportunity to mitigate risk and responds accordingly in a timely fashion, including encouraging local reporting of potential issues.
Contributes to development and implementation of system-wide compliance training programs. This includes participating in the preparation of presentation materials designed specifically to communicate and promote the understanding of compliance issues, laws, and consequences for noncompliance, as well as delivering the training programs throughout the system.
Oversees the thorough documentation of all compliance related activities for the system to ensure compliance with federally mandated reporting requirements. Ensures reporting requirements are maintained in a timely and accurate fashion for the system, including the resolution of each case/issue identified and closed. Reports on matters of business ethics, legal compliance and operations of the program.
Reviews highly complex and sensitive questions, concerns and complaints relative to compliance matters, and provides leadership and support to all entities as appropriate. Ensures that reasonable steps are taken to respond timely and appropriately to ethical or legal compliance violations, to prevent further violations and to advise regarding potential discipline of violators appropriately and consistently. Oversees questions of ethical and legal compliance to ensure consistency in the enforcement of the program.
Supports, through leadership and oversight, the assigned compliance management staff throughout their assigned facilities or areas, including providing ongoing support in the development of entity-specific compliance goals and objectives. Conducts entity site visits on an ongoing basis and communicates system trends and areas for improvement for the entity. This position also acts as a resource to entity compliance management as needed or requested to address and resolve compliance related issues. Chairs compliance committee meetings at appropriate levels based on the need and direction of the system and/or entity.
Maintains a current awareness of compliance-related laws and regulations, keeping abreast of current changes that may affect payer or health care systems through personal initiative, seminars, training programs and peer contact.
This position may supervise professional staff. This includes directing personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training and personnel evaluations.
Must possess a strong knowledge of business, payer and/or healthcare compliance as normally obtained through the completion of a bachelors degree in business administration, accounting/finance, or health care related field as appropriate for the position.
Requires knowledge of laws and regulations pertaining to health care, regulatory compliance, physician billing and information systems, Medicare/Medicaid and financial reimbursement systems.
Must possess strong planning skills and problem solving skills. Must possess strong oral and written communication skills to effectively interact with senior management team, physicians and federal and state regulatory entities. Must also possess highly effective negotiating skills to communicate and interact with senior management team, regulatory entities and/or physicians.
Masters Degree preferred; previous health care or academic compliance experience preferred; minimum 3 years of payer, healthcare or academic management experience preferred.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.