Svp, Compliance And Quality Assurance

Overview

Senior Vice President of Compliance and Quality Assurance

Reports to: Chief Legal Officer

FLSA: Exempt

This position serves as the Company's Compliance Officer, ensuring that the organization adheres to all applicable laws, regulations, and policies by developing, implementing, and monitoring compliance programs and functions that help the organization stay within legal and ethical boundaries. As a key member of the HealthPRO-Heritage leadership team, the Compliance Officer is responsible for identifying and assessing areas of compliance risk; implementing and maintaining a retaliation-free internal reporting process, collaborating with executive management to effectively incorporate the compliance program within Companywide operations and to carry out the responsibilities required of the position.

The compliance officer provides direction and oversight of the compliance program. The compliance officer is responsible for identifying and assessing areas of compliance risk; communicating the importance of the compliance program to the executive management and the board of directors; preparing and distributing the written code of conduct setting forth the ethical principles and policies which are the basis of the compliance program; enduring the implementing education programs addressing compliance and the code of conduct; implementing a retaliation-free internal reporting process, including an anonymous telephone reporting system; and collaborating with executive management to effectively incorporate the compliance program within system operations and programs and to carry out the responsibilities of the position.

Responsibilities

Primary Responsibilities:

• Creating, implementing, and maintaining an effective corporate compliance program

• Ensuring that the compliance program effectively prevents and/or detects violation of law, regulations, organization policies, or the code of conduct

• Regularly reviewing the compliance program and recommending appropriate revisions and modifications, including advising administrative leadership and the board of directors of potential compliance risk areas

• Coordinating resources to ensure the ongoing effectiveness of the compliance program

• Implementing and operating retaliation-free reporting channels, including an anonymous telephone reporting system available to all employees, volunteers, customers, and vendors

• Ensuring the adequacy of educational programs for all employees, agents, contractors, or others working with the organization

• Ensuring that the internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct by employees, agents, contractors, or others working with the organization

• Ensuring that the system has effective mechanisms to reasonably determine that persons either promoted to or hired in management and certain other sensitive and/or responsible positions (to be designated) do not have a propensity to violate laws and regulations or engage in improper or unethical conduct in their designated areas of responsibility

• Providing input to human resources policies and procedures and the performance appraisal and incentive programs to ensure that improper conduct is discouraged and that support of any conformity with the compliance program is part of any performance evaluation process for all employees

• Coordinating as appropriate with legal counsel, conducting or authorizing and overseeing investigations of matters that merit investigation under the compliance program

• Overseeing follow-up and, as applicable, resolution to investigations and other issues generated by the compliance program, including development of corrective action plans, as needed

• Tracking all issues referred to the compliance office

• Developing productive working relationships with all levels of management

• Presenting periodic and annual reports on the compliance program to the board of directors

• Developing and implementing, upon an approval by executive management and the board of directors, an annual review of an update to the compliance plan

• Reporting on a regular basis to the compliance committee on matters involving the compliance program. Additionally, the compliance officer at his or her discretion is expected to regularly report issues to the CEO and board of directors

• Working with administrative leadership to provide adequate information to staff to ensure that they have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities in a lawful and ethical manner

• Ensuring that all contracts contain language that is corporate compliant

• Representing the compliance committee, including developing appropriate agendas, reports, and information as directed from time to time by the committee

• Performing other duties as assigned

Principal Duties

• Oversee, coordinate, and monitor the day-to-day compliance activities of the organization

• In collaboration with internal stake holders, establish a company compliance manual; maintain and supplement the manual as necessary

• Develop and coordinate appropriate compliance training and education programs for all employees; ensure and understand the company's commitment to comply with all laws, regulations, company policies, and ethical requirements applicable to the conduct of the business; assess the need for additional training and education and develop appropriate compliance programs

• Develop, coordinate, and/or oversee internal and external audit procedures for the purpose of monitoring and detecting any misconduct or noncompliance; if any misconduct or noncompliance is detected, recommend a solution and follow up to ensure that any noncompliance is resolved

• Formalize and monitor a system to enable employees to report any noncompliance without fear of retribution, ensuring that the reporting system is adequately publicized and that allegations of noncompliance are investigated and responded to promptly.

• In consultation with the human resources department, help ensure that there is a mechanism in place for disciplining instances of noncompliance (including the failure to prevent, detect, or report any noncompliance), appropriate to the nature and extent of the deviation and ensure consistency in the application of disciplinary action

• Work with the human resources department to ensure a work force with high ethical standards, including the establishment of minimum standards for conducting appropriate background and reference checks on potential employees

• In conjunction with the legal department, interface and, when appropriate, negotiate with external regulatory agencies

• Report to the compliance committee at its regular meetings, or as otherwise necessary, on any significant compliance issues to ensure appropriate discussion of such compliance issues and to ensure that appropriate action is taken

• Carry out all duties and responsibilities as assigned by the compliance committee

Qualifications

Quality Assurance:

• Conduct data analysis related to billing, clinical documentation, and related compliance initiatives to assess program and to support the Corporate Compliance Plan

• Provide leadership to all clinicians in the promotion of the company's clinical and ethical values and commitment to

• Direct and facilitate investigations to assigned locations; support the utilization of the compliance hotline; report suspected fraud or other improprieties without fear of retaliation and provide ongoing

• Design and implement quality assurance guidelines to assist in the delivery of services to include peer review, chart and billing audits and suggestions for

• Develop and oversee systems for ensuring that the quality and appropriateness of resident care meets and exceeds company standards as well as being in compliance with state, federal, legal, regulatory, accreditation and reimbursement guidelines.

• Lead, facilitate, and/or advise quality teams

Regulatory Compliance and Reimbursement Expertise:

• Be a resource for associates and customers with regard to coverage guidelines and the payment systems across the service lines, including skilled nursing, senior living, outpatient, pediatrics, and home health

• Provide regulatory expertise to the Executive Team and project teams. Interact with the Executive team to help define the Regulatory Strategy for both internal and partnership programs.

• Serve as the regulatory representative on relevant project teams

• Facilitate relationships within the industry to better prepare the organization for opportunity/ mitigate risk

• Provide Regulatory updates and strategic input to Executive team

Consultation Developement

Assist facilities with needs during Annual Certification Surveys, Licensure Surveys and Complaint Liaise with other consultants, with complimentary expertise to be a resource to our customers and potential customers.

Knowledge and Skills

Minimum of five years of work experience in a contract therapy setting is preferred; degree from an accredited College or University as a licensed Physical Therapy, Physical Therapist Assistant, Occupational Therapist, Occupational Therapy Assistant or Speech/Language Pathologist is preferred with licensure or eligibility for licensure in all states the company provides Proven leadership skills in the healthcare Knowledge of and ability to perform skills related to management, planning, program development and budgeting. Excellent communication and interpersonal Proficient use of personal computer and software applications used in job functions including but not limited to word processing, graphics, databases, spreadsheets, and electronic medical record Knowledge of basic business accounting and interpretations of financial Must possess a thorough knowledge of Medicare, Medicaid, private pay, and any other governmental and regulatory agencies involved in skilled nursing, senior living, outpatient, pediatrics, and home health Must possess a good working knowledge of Medicare/PPS, Managed Care or any other reimbursement systems as it relates to reimbursement Must hold a Certified in Healthcare Compliance and possess and/or obtain further certification through programs meant to develop additional expertise, including but not limited to MDS RAC-CT, OASIS-D, QAPI, RHIT, Must be knowledgeable of general laws, regulations and guidelines governing long-term Must be able to communicate effectively with residents, facilities, personnel and support Communicates effectively and professionally in all situations with varying personalities of customers, potential new hires, employees and management Able to adapt to changes in the work environment, can handle various demands and unexpected events Maintain confidentially of company employee information Attention to detail to ensure accuracy and completion Identifies problems and resolves them in a timely manner Prioritizes work activities to ensure all tasks are completed in a timely manner

Work Environment

This job operates remotely in the associate's home office with field travel to support compliance team initiatives as assigned. This role routinely uses standard office computer equipment such as laptops, software programs, etc.

Position Type/Expected Hours of Work

This is a full-time salaried position. Some flexibility in specific work hours is allowed, and must work required hours each week to maintain full-time status.

Travel

Must be willing to travel overnight frequently as needed.

HIPAA & THE MINIMUM NECESSARY STANDARD

The Employee shall maintain the confidentiality of all protected health information (PHI) whether electronic, written or oral to which he/she may be exposed either during the course of their duties or the result of an incidental disclosure. In accordance with the minimum necessary standard, the employee may only access PHI to perform the job as a Compliance Coordinator.

• View, create, add, and modify all clinical and demographic protected health

• Disclose clinical and/or demographic protected health information for the purpose of patient treatment, healthcare operations and/or payment for services.

• Disclose all protected health information for any authorized

• The minimum necessary standard must be applied in all matters and shall continue privacy protection during non- working hours and after employment is no longer with the

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

EEO Statement

HealthPRO Heritage and its subsidiaries provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, HealthPRO Heritage and its subsidiaries comply with applicable state and local laws governing nondiscrimination in employment in every location in which the company facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Recruiter : Email Address

michael.kinney@healthpro-heritage.com