General Summary: The Compliance Program Manager (CM) will assist the Senior Director, in conducting compliance reviews and audits, updating and verifying Beaumont Health (BH) policies and procedures to comply with federal and state laws and regulations, as well as ensuring that services are performed or conducted in a manner consistent with applicable regulatory requirements. In collaboration with the BH Compliance Leadership Team, the CM will develop and implement compliance processes, conduct research of laws and regulations, make compliance risk plan and program recommendations, and assist in the development of compliance education.
Essential Duties:
Monitors/investigates/recommends action on matters involving:
o BH operational performance related to compliance;
o Unethical conduct;
o Documentation, billing, coding, claims, and/or payment;
o Compliance with state and federal regulations as applicable to BH and its divisions; and
o Inquiries and complaints made to the Compliance Office;
Researches and analyzes federal and state laws and regulations, pronouncements such as OIG fraud alerts, and case law that govern BH, as well as provide updates to appropriate groups.
Assists groups with implementation of responsive measures to better ensure BH compliance;
Provides general compliance training with documentation of content and attendance;
Coordinates with Internal Audit and others regarding billing and coding compliant practices and development of pertinent educational programs;
Routinely monitors corrective measures to ensure ongoing compliance;
Prepares reports for various committees as appropriate;
Assists/conducts/coordinates audits of BH services for compliance with federal and state law and regulation.
Standard Qualifications:
Bachelor's degree in business, accounting, health administration, computer science, health information management, or related field is required. MBA or JD preferred.
Strong working knowledge of federal and state laws and regulations as they pertain to health care, service documentation, coding rules and standard practices, billing rules, information privacy/security law and regulation is highly desirable.
Candidates with experience in a large, complex corporate environment with contracting or contract management experience are preferred.
Knowledge of the HIPAA Security and Privacy rules, Medicare Conditions of Participation, and state facility licensing requirements are desirable.
