Manager, Compliance

Company Overview

National Partners in Healthcare (NPH) is a progressive healthcare company specializing in anesthesiology. We partner with physicians and health systems to deliver high quality care, aligning synergies and best practices to achieve superior outcomes. As a leader in the industry, we believe in developing a foundation of trust, transparency, and excellence in everything we do. The success of our company has created excellent career advancement opportunities that support a healthy work/life balance.

Develop, direct and manage the Compliance Program. To ensure compliance with Code of Conduct, HIPAA, Antitrust and with state and federal laws and regulations governing healthcare.

• Work with company leaders to accomplish annual goals and objectives for the corporate compliance plan.
• Maintain, disseminate, and act upon knowledge of all applicable rules, regulations, policies, procedures, guidelines, and laws to ensure compliance with all regulatory bodies.
• Evaluate and revise the organization’s Compliance Plan on an annual basis along with applicable policies and procedures.
• Chair and conduct regular meetings of the Corporate Compliance Committee where applicable issues, projects and updates related to Compliance are discussed and considered.
• Develop and oversee educational training courses including Code of Conduct training, Compliance Policy and Procedure training, Compliance laws and regulations training.
• Conduct and manage internal audits for billing and operational centers. Participate in meetings, calls regarding significant carrier audits, investigations and disclosures.
• Work with regulatory, law enforcement, and accrediting agencies and staff as needed.
• Extensive interaction with Providers, Information Services, Billing, Credentialing, Patient Financial Services, Legal, Human Resources and Risk Management departments and functions.
• Prepare management reports, documents, etc. as required including financial, investigative, and operational; present Compliance updates and reports to the Board on a regular basis.
• Ensure maintenance of compliance records including review logs, hotline logs, inquiry logs.
• Direct the preparation and maintenance of billing and coding audit and project reports; prepare periodic reports for presentation for Board of Directors and senior management as required.
• Responsible for executing internal audit plan.
• Oversee provider and employee Compliance training as well as ensure that all applicable exclusions list and sanction checks are completed for providers and applicable employed staff.
• Identify and communicate internal control deficiencies; document and communicate changes to the internal control system.
• Implement and maintain the Compliance Hotline service and oversee any inquiry or investigation related to reports made to the hotline.
• Respond to all complaints and concerns regarding billing, coding, third party audits, and provider contracts on a timely and thorough manner.
• Keep CEO, President and General Counsel informed of any issues, audits, etc..
• Adhere to all company policies and procedures.
• Adherence to and compliance with information systems security is everyone’s responsibility. It is the responsibility of every computer user to:
  Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems.

• Perform other duties as assigned.
• Travel is required approximately 30% of the time.

• A Bachelor’s degree is preferred.
• Master’s Degree in relevant field a plus.

• 5 - 10 years previous healthcare related experience, including knowledge of clinical records and healthcare billing.
• 2-3 years of previous audit experience is required in healthcare or regulatory agency setting; or an equivalent combination.

• Ability to Travel 30% of the time.
• Broad understanding and familiarity of common business functions including accounting, finance, HR, RCM, marketing, credentialing, managed care contracting etc.
• Bias for action /…