VP of Compliance

Job Summary Job Summary: The VP of Compliance will be responsible for managing and coordinating compliance processes and procedures across organizational and functional areas to promote compliance with federal, state, and local laws, rules and regulations. Working in partnership with Senior Management to develop and communicate mission and vision for compliance and to develop and implement appropriate policies, procedures and other tools to realize that vision. Responsibilities Manages various compliance program activities at the direction of the CCO. Assist in the establishment departmental goals and objectives that are consistent with, and lead to the successful achievement of, divisional and corporate goals and objectives. Achieve departmental goals and objectives by providing effective leadership, management, strategic direction, and budget and business planning. Assist in analyzing the OIG Workplan and other relevant guidance, and develop an annual audit plan with the assistance of compliance team and the Executive Compliance Committee to identify and prioritize compliance risks throughout the organization. Assist in the designing, planning, and performance of compliance monitoring activities with respect to the annual audit plan. Delegate compliance responsibilities to team members and supervise these activities to ensure proper completion and follow-up. Document and report the results of the compliance activities to the CCO in a timely manner. Investigate and prepare responses to audits performed by outside agencies, including the OCR, CMS, CMS contractors, the OIG and managed‑care insurance agencies. Prepare appeals of adverse decisions resulting from external audit activities. Provide advice and assistance to management on compliance issues and related opportunities for process improvements. Perform internal compliance investigations and audits throughout the organization, including compiling detailed reports, making recommendations and implementing corrective actions to the CCO and other senior management staff actions, as appropriate. Monitor legal and regulatory developments relating to Essen operations and advise applicable departments of these developments. Maintain current knowledge of relevant regulatory guidelines, pertinent regulations, and government enforcement initiatives. Continually assess the effectiveness of departmental functioning, including the people, processes, and technologies needed to achieve departmental and corporate goals and objectives. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance. Assist in the direction of the planning, design, development, implementation and evaluation of policies and procedures that assure the Corporate Compliance Program activities are managed effectively. Identify areas of potential vulnerability and risk, develop corrective action plans, and provide general guidance to address issues. Provide oversight in the development, implementation, and monitoring of the compliance program training materials, and be able to conduct compliance training as needed. Qualifications At least five (5) years in the healthcare compliance industry, including previous management experience. A minimum of two (2) years’ experience in medical coding and reimbursement, auditing or healthcare clinical activities. Full understanding of the healthcare regulatory industry, with experience in conducting complex compliance investigations. Must have the ability to carry out non‑routine procedures under constantly changing conditions. Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint. Bachelor’s degree or higher in a business or healthcare related field. Certification in Healthcare Compliance (CHC) or Certification in Compliance & Ethics Professional (CCEP), required. Certification in Medical Coding or Auditing: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or Certified Professional Medical Auditor (CPMA), preferred. Certification in Healthcare Privacy Compliance (CHPC), preferred. Certification in Healthcare Research Compliance (CHRC), preferred. Salary: $150,000-$200,000 Equal Opportunity Employer Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population. #J-18808-Ljbffr