Director of Program Compliance

SUMMARY

The Director of Program Compliance reports to the Chief Program Officer (CPO), actively participates as a key member of an AHS Program team and is responsible for the company's compliance with Federal, state, local and internal compliance requirements and will lead other program initiatives as defined by the CPO. The Director will serve as a primary organizational resource for written standards of conduct, compliance oversight, education and training, communication systems, audit and monitoring, response, prevention, and enforcement activities and acting as a consultative resource for corporate quality, risk, compliance, and policy issues.

GENERAL SCOPE OF RESPONSIBILITIES

• Ensure Compliance with federal HIPAA and other requirements and disseminating information to and educating colleagues regarding a broad spectrum of compliance related topics (e.g., Fraud and Abuse Laws, Conflict of Interest, privacy and security, ethics and integrity, etc.)

• Participate in ODP licensing of 6500,6400 and 6100 regulations and maintain a current working knowledge of Federal and State regulations and policies as they affect through routine review of various standards (such as Pennsylvania Code 6400 regulations, Bulletins, etc.), Federal Register notices, applicable government and/or industry-related internet information sites, multiple stated Medicaid manuals, and multiple State Board regulations.

• Maintain the effectiveness of the Corporate Compliance Program including but not limited to the creation/revision of applicable Business Practice (procedures) and System Wide policies, measurement of compliance by conducting routine and/or focused internal audits of policy/procedure adherence as well as coordinating audits generated by external sources, developing, coordinating and participating in routine activities that focus on the elements of the Compliance Program (education, monitoring, reporting, auditing, etc.) ensuring that all appropriate employees and management are knowledgeable of, and comply with, pertinent Federal and State Health care program requirements.

• Protect organizational interests which may be affected by proposed legislative and/or regulatory issues including but not limited to communicating and coordinating comments/concerns regarding proposed policies/legislation or impending implementation of policies to appropriate legislators, officials, industry organizations, customer base or other entities as applicable and developing and maintaining image as a key player and ethical voice in related ID/A care and support issues (such as policy changes on technology and value based payment models).

• Coordinate and support assigned short-term and long-range projects including current and additional projects as assigned:

• Implementation and ongoing oversight of Station MD

• The Horizon software implementation towards the development of an Electronic Health Record (EHR)

• Working with the CPO to develop and implement a plan meet the criteria to meet the requirements of a "Preferred Provider"

• Assist the CPO and CAO in developing and implementing the UPMC "Honest Broker" program for individuals served by AHS

• Identify policies that ensure compliance and Best Practices throughout AHS.

• Will assist in any mergers, partnerships, or acquisitions

KNOWLEDGE, SKILLS, ABILITIES

• This is a senior level position, salaried, exempt and requires extensive experience in a variety of business disciplines and organizational levels - both in size and scope.
• Masters degree preferred and a minimum of five (5) years experience working in management of an organization and in development, implementation and achievement of plans, programs and objectives.
• The incumbent has advanced interpersonal communication skills, demonstrated problem-solving ability, and in-depth knowledge of inner workings of multiple functional areas.
• Excellent interpersonal, communications, public speaking, and presentation skills.
• Ability to effectively present information to top management, public groups, and/or boards of directors.
• Must be able to pass a pre-employment criminal background check and child abuse clearance.

EXAMPLES / DETAILS OF RESPONSIBILITIES

• This key position acts as a Corporate and Program Compliance Officer, and in addition to frequent special projects acquisition integration, procurement and business development.
• May be called upon frequently to present/report to a Board of Directors.
• Oversees specified aspects of direct day-to-day operation and indirectly monitors the work life health & welfare of 600+ employees.
• Reviews, approves and ensures compliance to long and short-term organizational objectives. Monitor and develop policies and actions relating to issues of governmental concerns.
• Assisting the CPO with managing work processes that effect AHS operations
• Will work directly with the CPO on all monitoring/licensing reviews by County and State regulatory bodies.
• Work with Senior Management in improving processes & quality and implementing solutions across the organization.
• Participate in strategic development, acquisition analysis and due diligence. Leads the team to successfully integrate acquisitions.
• Acts independently, restricted by company guidance, policies and objectives.