Careers in Quality

Summary

Under minimal supervision, the Hospital Compliance Manager is responsible for communicating, driving and proactively monitoring compliance with all applicable federal and state laws, regulations, policy directives and ethical requirements for the Denver Health and Hospital Authority (DHHA) Denver Health Medical Center (DHMC), Federally Qualified Health Centers (FQHCs) and all other healthcare provider services. This position exercises responsibility and authority for developing, implementing, and managing the compliance program for DHHA provider services at the direction of the Director of Hospital Compliance and the Chief Compliance and Audit Officer. This position works with executives, operations leaders, external government agencies and parties as well as legal counsel when appropriate. Provides guidance, oversees day-to-day operations, coaches and develops the Hospital Compliance team.

Responsibilities

1. Monitor and analyze federal and state regulations of relevance to DHHA, DHMC, and FQHCs, and report out on the associated risks and operational impact of such regulations to operational leadership. 2. Oversee and coordinate activities of the DHHA hospital provider compliance program at the direction of the Director of Hospital Compliance and Chief Compliance and Audit Officer. 3. Support the Director of Hospital Compliance with enterprise conflicts of interest policy implementation including annual questionnaire facilitation and disclosure review and management processes. 4. Support the development and implementation of effective compliance communication and education programs for the DH enterprise with specialized focus on DHMC and FQHC services addressing such matters as (a) the appropriate use of the Compliance Hotline and Ethics Point; (b) the need to adhere to the Standards of Conduct, and (c) the effect of existing and proposed laws, regulations, guidance, coding rules, billing requirements, enforcement trends, industry standards and best practices. 5. Oversee the sanction screening process for the DH enterprise in collaboration with the Director of Health Plan Compliance. 6. Support the response to external audits and activities for DHHA and its healthcare services. 7. Respond directly to internal/external customers regarding both DH enterprise policies and DHMC and FQHC focused policies and assist them in interpretations, application, and revisions where necessary. 8. Provide technical and regulatory guidance to all departments on compliance matters to ensure compliance with applicable regulations and standards. 9. Participate in workgroups and provide advisement related to compliance with applicable regulatory, contractual, internal or other requirements. 10. Assist in the investigation of reports or evidence of misconduct or non-compliance, and recommend and track corrective actions including training and application of DH accountability based performance principles and practices. 11. Support and track compliance monitoring activities for the DHMC and FQHC and other provider services and locations. 12. Actively support the Director of Hospital Compliance to include the ability to function as a substitute at business partner meetings and to provide guidance on complex issues. 13. Assist in developing, implementing, evaluating, and updating compliance policies and procedures and the Enterprise Compliance Services (ECS) work plans. 14. Assists with periodic review and updating of the compliance program to help ensure continued program effectiveness and inclusion of new, revised or amended laws, rules or regulations. 15. Conduct research into new and revised regulations applicable to the organization's operations and provides recommendations to the Director of Compliance and Internal Audit regarding potential implementation. 16. Perform compliance monitoring and auditing activities of high risk areas. 17. Provides guidance, oversees day-to-day operations, coaches and develops the Hospital Compliance team. 18. Other duties as assigned.

Knowledge, Skills & Abilities

Minimum Qualifications Education and Experience 1. Bachelor’s Degree required. 2. Master’s degree in a related area or a degree in law is preferred. 3. Seven years’ experience in hospital or other healthcare provider setting required. 4. One year in a leadership role required. 5. Significant experience in the healthcare hospital or other provider setting with specific ethics/compliance program experience or legal/regulatory experience preferred. Knowledge, Skills and Abilities 1. Strong interpersonal, communication, and leadership skills. 2. Strong acumen and understanding of healthcare, state and federal healthcare regulations, laws and governmental hospital and provider-specific compliance program guidance. 3. Ability to perform detailed research and online searches of laws, regulations, industry best practices, and governmental guidance that might affect the organization’s compliance practices, and translate regulatory requirements into summaries and terms readily understood by audiences at various levels of the organization and external clients. 4. Ability to effectively present information and respond to inquiries from employees, regulatory agencies, and others, as necessary. 5. Perform detailed work accurately and take initiative to learn new tasks. 6. Excellent organizational and analytical skills. Ability to work well both independently and with others in a matrix environment. 7. Able to follow directions and work independently. 8. Strong project management skills and experience. 9. Concurrently handle multiple projects and tasks. 10. Strong analytic, critical thinking, and technical skills. 11. Strong problem solving skills, with the ability to identify and resolve problems of moderate complexity. 12. Consistently demonstrate a high standard of personal and professional conduct, ethics, objectivity, judgment, and discretion. 13. Communicate clearly, concisely and effectively; experience in business presentations and public speaking. Computers and Technology 1. Proficient in Microsoft Office Suite. 2. Experience with QNXT claims processing system and Altruista is preferred. Certificates, Licenses and Registration 1. Certification in Healthcare Compliance and/or Compliance & Ethics Professional Certification or other nationally recognized certification preferred 2. J.D. or M.L.S with specialization in healthcare compliance preferred. Supervisory Responsibilities This position will be responsible for, but not limited to, hiring, terminating, performance management, coaching, supervision, fostering teamwork, training and development of one or more employees.

Education

• Bachelor's Degree (Required) Seven years’ experience in health plan compliance, law/regulations required. One year in a leadership role required.
• Master's Degree