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Organization:
SHSO-Sutter Health System Office-Valley
Position Overview:
Assists the ethics & compliance officer or ethics & compliance leadership in the oversight and administration of the ethics & compliance program at designated entity to ensure compliance with the organization’s policies and procedures and applicable state and federal laws, regulations, and standards (e.g., Physician Self-Referral laws, Anti-Kickback statues, fraud, waste and abuse laws, requirements for managed care plans, value-based care and alternative payment models, and other compliance laws). Works with and serves in the absence of ethics & compliance officers in overseeing, coordinating, implementing, administering, and evaluating the Sutter Health ethics and compliance program at assigned entity within a market/network/service line(s). May serve as a member of entity senior leadership team and collaborates with entity senior leadership and organizational staff throughout the market/network/service line(s), ethics and compliance staff, and Legal & Risk Services team members regarding changes in federal and state laws and regulations 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. Conducts investigations at levels of risk and reports on 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.
• Will monitors laws and regulations that apply to designated entity operations and leads response efforts for select government inquiries, regulatory filings, and audits.
• In-depth knowledge of managed health care, value-based care, and alternative payment models is needed.
Job Description :
The person hired for this role must live in the Nothern California Sutter Health footprint and come on site for meetings, work, etc.
This role will cover CHA (Comprehensive Health Assessment Program), SHSO (Sutter Health System Office), and SMN (Sutter Medical Network).
Travel across the system will be required as needed for this role.
CRC (Certified Risk Adjustment Coder) is highly desired for this role.
EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma
Bachelor’s in Business Administration or related field
CERTIFICATION & LICENSURE:
CHC -Certified in Healthcare Compliance
TYPICAL EXPERIENCE:
8 years recent relevant experience
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 training.
In-depth 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), 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 timeframes 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 invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.
Maintain strict confidentiality of sensitive material (compliance and risk management data) and ensure the privacy of each patient’s protected health information (PHI).
Work effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.
Build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.
Job Shift :
Days
Schedule :
Full Time
Shift Hours:
8
Days of the Week:
Monday - Friday
Weekend Requirements:
None
Benefits:
Yes
Unions:
No
This position is work from home eligible.
Position Status:
Exempt
Weekly Hours:
40
Employee Status:
Regular
Number of Openings:
1
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $62.95 to $94.43 / hour
The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.
All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.