Program Manager, Compliance - Work From Home

Sutter Health Remote
program manager manager compliance work from home compliance healthcare regulations compliance officer officer procedures legal management education
January 22, 2023
Sutter Health
Sacramento, California
Organization:SHSO-Sutter Health System Office-Valley Position Overview: Works with the Chief Compliance Officer, OU Compliance Officer, affiliate Compliance Officers and other Ethics & Compliance team members to assure compliance with Physician Self-Referral laws, Anti-Kickback statues, fraud, waste and abuse laws, and other compliance laws and the organization's policies and procedures. Works with and serves in the absence of the Compliance Officer in overseeing, coordinating, implementing, administering, and evaluating the Sutter Health Ethics and Compliance Program at assigned affiliate(s). Collaborates with affiliate organizational staff, Ethics and Compliance staff, and OGC team members (e.g., Legal, Risk Services) regarding changes in federal and state laws and regulations for healthcare providers and the organization's policies and procedures. Plans, executes, and leads a variety of regulatory compliance based projects. Leads in the day-to-day management of ethics and compliance incident response process. Partners with the Compliance Officer to conduct and report on internal investigations and compliance risk assessments and assists with the development of compliance policies and procedures. Serves as a resource person to perform the various activities of the Ethics and Compliance Program and includes monitoring, investigation coordination, data quality assurance, training and education, and managing any confidential reporting received via mailbox or phone messaging. This position will perform trending, analysis and metric reporting related to ethics and compliance incidents and make recommendations for control implementation, education opportunities and remediation Job Description :EDUCATION Bachelor's: Business Administration or related field or equivalent education/experience CERTIFICATION & LICENSURECHC-Certified in Healthcare Compliance within 1 Year of hire EXPERIENCE5 years experience in a healthcare compliance related role SKILLS AND KNOWLEDGE In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting and documenting investigations, addressing violations, tracking corrective actions, and knowledge of healthcare clinical operations, hospital revenue cycle systems, and healthcare billing and coding requirements. Working knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources. Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws. Exceptional attention to detail with excellent time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines. Strong business acumen and exceptional analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes. Excellent written/verbal communication, interpersonal, and presentation skills with the ability to translate complex legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences. Proficient computer skills, including advance competency in Microsoft Office Suite (Word, Excel, Visio, Project, and PowerPoint), SAP SE Crystal Reporting, and other software. Ability to manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function. identify potential concerns and compliance issues, and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem. advise management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations. abstract information from medical records, reports, chart entries, related patient documentation, and interviews while conducting audits and investigations. work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established time frames and government regulations. direct, prioritize, and drive multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget. make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions. foster an open and collaborative environment that

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