Job Information
CommonSpirit Health Division Director Provider Compliance CRO in Greenwood Village, Colorado
Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
*Candidates required to live in Ks, Co, or UT.
Responsibilities
Job Summary / Purpose
Shares accountability in the planning, design, implementation and maintenance of system-wide physician enterprise compliance programs and associated policies and procedures in specific assigned markets/divisions. Operates in an independent and objective manner and serves as the compliance expert regarding State and Federal laws and regulations that govern CommonSpirit Health and its relationships with physicians and Advanced Practice Providers. Maintains an in-depth understanding of CommonSpirit Health physician enterprise operational and business practices and physician integration strategies.
Essential Key Job Responsibilities
Monitors, disseminates and provides consultation, pertinent to laws and regulations and/or revisions to laws and regulations as they relate to physician enterprise compliance. Examples of these include, but are not limited to, the Federal Sentencing Guidelines, Physician Self-referral law, HIPAA, and the Affordable Care Act. Such guidance, laws and regulations may come from many agencies including but not limited to: The Office of the Inspector General (OIG), Centers for Medicare and Medicaid (CMS), Department of Justice (DOJ), Internal Revenue Service (IRS), state regulatory agencies, etc.
Works closely with legal services and other applicable functional areas to ensure proper interpretation, dissemination and education regarding laws and regulations affecting physician business relationships.
Provides leadership for the development and evaluation of policies, procedures, tools and templates and/or corrective action plans to address current laws and regulations and/or revisions to current laws and regulations related to physician enterprise compliance.
Develops monitoring plans, policies and education to mitigate or correct identified problems, and advises management regarding the development of corrective action plans.
Identifies key areas for training and education related to physician enterprise compliance objectives.
Analyzes reports, data, trends and governmental enforcement efforts to keep management and governance informed of the current regulatory environment and the potential impact to CommonSpirit. Works with departmental and functional leadership to develop and assess physician and clinical outlier risks through analysis of billing and quality data.
Coordinates/oversees compliance issue reporting through resolution.
May supervise facility compliance staff and be responsible for hiring, performance evaluations, coaching and development.
Qualifications
Required Education and Experience
Bachelor’s Degree; Master’s Degree strongly preferred
Minimum of seven (7) years’ experience in healthcare regulatory or operational compliance.
Minimum of five (5 years) leadership experience in the healthcare field.
Required Licensure and Certifications
- One of the following is preferred upon hire or required within the first year of employment: Certified in HC Compliance ( CHC) , Certified Compliance and Ethics Professional (CCEP).
Required Minimum Knowledge, Skills, Abilities and Training
Experience in development and implementation of facility-wide policies and/or practices.
Success with identifying and resolving operational issues.
Success working collaboratively with other discipline leaders to accomplish goals.
Excellent problem-solving skills
System-thinking, considering widespread effects of decisions and actions
Ability to work independently while managing multiple complex projects simultaneously
Ability to research complex, legal, regulatory and contractual documents for interpretive purposes.
Working knowledge of regulations and accreditation standards, knowledge of specific state and federal requirements and standards related to the healthcare industry.
Working knowledge of healthcare billing and coding compliance and healthcare program reimbursement regulations and guidance.
Ability to collect, organize and analyze data and information
Change management techniques
Pay Range
$62.51 - $90.64 /hour
We are an equal opportunity/affirmative action employer.