Compliance Officer

Job Description

Job Description

The Compliance Officer is responsible for administering and continuously improving the organization's Corporate Compliance Program and promoting an organizational culture of ethical conduct, accountability, and compliance.

The position develops and implements the annual Compliance Work Plan and organizational compliance risk assessment; coordinates compliance education, monitoring and auditing; evaluates and responds to reported compliance concerns; and works collaboratively with leadership, legal counsel, Finance, Revenue Cycle, Human Resources, Medical Education, and clinical departments to identify and mitigate organizational risk.

The Compliance Officer serves as a resource to leadership, physicians, residents, advanced practice providers, faculty, and staff regarding applicable federal and state healthcare requirements and organizational compliance expectations.

What You'll Do

• Administer, maintain and continuously improve the CMEP Corporate Compliance Program consistent with applicable federal and state requirements and relevant governmental guidance.
• Develop and implement the annual Compliance Work Plan and organizational compliance risk assessment.
• Chair and coordinate the CMEP Compliance Committee, including development of agendas, documentation of activities and follow-up on identified compliance matters.
• Provide appropriate compliance reporting to the Chief Medical Officer, executive leadership and Board.
• Maintain and periodically evaluate compliance-related policies and procedures.
• Develop and coordinate compliance education for employees, physicians, faculty, residents and other applicable workforce members.
• Promote accessible mechanisms for employees and providers to raise compliance concerns without fear of retaliation.
• Receive, evaluate, document and coordinate investigation of reported or suspected compliance concerns.
• Work collaboratively with legal counsel when matters require legal review or attorney-client privilege.
• Coordinate appropriate corrective action, follow-up and monitoring when compliance concerns are substantiated.
• Conduct or coordinate periodic auditing and monitoring of identified areas of compliance risk.
• Monitor professional billing, coding, documentation and related revenue-cycle practices for compliance with applicable requirements.
• Partner with Revenue Cycle and Finance to identify documentation, charge capture, coding, billing or collection trends presenting compliance or revenue-integrity risk.
• Monitor applicable regulatory developments and communicate material changes to appropriate organizational stakeholders.
• Support organizational compliance with applicable fraud, waste and abuse requirements and federal healthcare program requirements.
• Coordinate exclusion screening and other compliance monitoring processes, as applicable.
• Assist leadership in identifying emerging compliance risks associated with new programs, affiliations, contracts or operational changes.
• Maintain appropriate compliance documentation and records.
• Prepare compliance reports and metrics for leadership and governance review.
• Serve as a neutral and accessible organizational compliance resource.
• Perform other related duties as assigned.

What You'll Bring

• Bachelor's degree in healthcare administration, Business Administration, Finance, Compliance or related field, or an equivalent combination of education and relevant experience.
• Minimum three to five years of progressively responsible experience in healthcare compliance, revenue integrity, professional billing, healthcare administration or a related field preferred.
• Working knowledge of healthcare compliance principles, professional billing/documentation requirements and federal healthcare program requirements.
• Experience conducting or coordinating audits, investigations, risk assessments or compliance monitoring preferred.
• Experience within a physician practice, academic medical organization or medical education environment preferred.

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CMU is an AA/EO institution, providing equal opportunity to all persons, including minorities, females, veterans, and individuals with disabilities.