Director Of Compliance Risk Managment

Job Description:

Job Title: Director of Compliance Risk Management

Location: Springfield, MO

Department: Compliance and Integrity

Employment Type: Full-time

Shift: Monday

• Friday 8:00 A.M.

• 5:00 P.M

Job Summary:

The Director of compliance Risk Management plays a vital role in ensuring the integrity of healthcare services provided to our community. This position strategically identifies and mitigates potential risks, conducts comprehensive audits, and oversees compliance efforts to maintain ethical billing practices and regulatory adherence. By joining our team, you'll contribute to upholding the highest standards of care and foster trust in the healthcare system.

As the Director of Compliance Risk Management, you'll be responsible for conducting routine compliance risk assessments, developing and implementing internal audit work plans, analyzing audit reports, and overseeing audit coordination. You'll investigate suspect billing practices, analyze claims data for potential fraud, waste, and abuse patterns, and provide guidance on coding, billing, and documentation requirements. Additionally, you'll supervise and train the audit team, prepare and present audit activity reports, and ensure the confidentiality of business information.

The Director of Compliance Risk Management position offers...

• All-Inclusive Employee Benefits Package

• A robust employee benefits package encompassing health, dental, vision, retirement, disability, life insurance, wellness program, and more

• Telemedicine -- 24/7 phone, web, or mobile app medical, behavioral health, & dermatology visits with copays as low as $15 if enrolled in health benefits

• Employee Assistance Program -- 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost

• Paid Time Off

• 29 days per year including vacation & holiday pay

• Premier Training

• Encompassing initial immersive onboarding, continuous skill enhancement, comprehensive curricula, and a supportive learning atmosphere.

• Professional Growth Pathways

• Abundant prospects for upward mobility and advancement, fostered by a promotion-from-within philosophy

• Workplace Culture

• An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting healthy, joyful workforce engagement

Key Responsibilities:

• Conduct routine Compliance Risk Assessments with Brightli System Members

• Develop and implement internal audit work plans based on Compliance Risk Assessments and ongoing billing/documentation trends

• Update internal audit work plans regularly based on Compliance Risk Assessments and ongoing billing/documentation trends

• Receive, analyze, and maintain internal and external audit reports

• Oversee the development and maintenance of audit tools

• Administer internal auditing programs per best practices and internal work plans

• Supervise coordination of internal and external audit activities

• Track development and implementation of corrective action plans from audits

• Conduct and direct investigations into suspect billing for Federal health care program overpayments

• Analyze claims data for potential fraud, waste, and abuse patterns

• Prepare and present audit activity reports to Compliance Committees and People Leaders

• Provide guidance on coding, billing practices and documentation requirements

• Supervise Lead Compliance Audit Coordinator and train Audit Team Members

• Maintain work papers, files, and documentation per regulatory requirements

• Ensure confidentiality of business information, including protected Health Information (PHI), as per HIPAA and company policy

Education and/or Experience Qualifications:

• Bachelor's degree from an accredited college or university in Health Information Management, Healthcare Compliance or related field required

• At least one of the following credentials (RHIA, RHIT, CHC), required

• Three to five years' experience in healthcare related compliance, auditing or health information management

Required License/Certification (one of the following):

• RHIA (Registered Health Information Administrator)
• RHIT (Registered Health Information Technician)
• CHC (Certified in Healthcare Compliance)

Additional Qualifications:

• High energy, motivated personality who enjoys researching and learning new things

• Ability to develop a vision and strategically work toward the vision

• Ability to develop and maintain timelines

• Ability to organize people and projects

• High level communication skills

• Able to develop written reports and communicate results in a positive and collaborative way both verbally and in writing

• Can work well with others and build relationships of trust with management

• Ability to exercise independent decision making

• Positive team player

Supervisory Requirements:

• Communicate the strategic direction of the organization and encourage participation by all employees

• Provide leadership and guidance to all aspects of the department

• Take an active role in monitoring the identification, development, and execution of strategic objectives

• Involve, as appropriate, all employees in order to achieve goals

• Effectively communicate to employees any changes and newsworthy events within the department or company

• Handle difficult employee situations directly, using appropriate discretion and Human Resource advice to show respect for the individual

• Champion change and effectively manage the implementation of new ideas

• Reinforces team approach throughout functions; support and solicit input from team members at all levels with the company

• Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy

Employment Requirements:

• Successful completion of background check including criminal record, driving record, abuse/neglect

• Completion of New Hire Orientation at the beginning of employment

• All training requirements including Relias at the beginning of employment and annually thereafter

• Current driver's license, acceptable driving record and current auto insurance

Physical Requirements:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

• While performing the duties of this job, the associate is frequently required to sit and stand for extended periods (2-4 hours); walking may be required for short periods when conducting field-based activities

• They must frequently use hands and fingers to write, type, operate a mouse, file documents, and otherwise handle documents

• They must occasionally lift and/or move up to 50 pounds

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Preferred Family Healthcare is a Smoke and Tobacco Free Workplace.