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Director Compliance Ensemble Health Partners (North Carolina) in Huntersville, NC at Mercy Health

Date Posted: 10/10/2018

Job Snapshot

Job Description

Job Summary

Under the direct supervision of the AVP, compliance, Revenue Cycle, this position contributes to the Mercy Health and Ensemble mission and vision by providing day-to-day management and integration of an effective compliance program related to Ensemble revenue cycle-third party billing Corporate Responsibility Program (CRP) and the overarching efforts of Mercy Health Revenue Cycle Compliance.  Ensemble RMC LLC is a owned subsidiary of Mercy Health and provides a wide-range of revenue cycle services to Mercy Health and non-Mercy Health clients.  This position provides compliance program-related oversight relative to Mercy Health and Ensemble operations conducted at remote locations (North Carolina).

Essential Functions

  • Responsible for the overall implementation and day-to-day management of the Revenue Cycle compliance program that meets or exceeds the requirements of an effective compliance program, as defined in the Federal Sentencing Guidelines and OIG Program Guidelines, under the supervision of the AVP, Compliance, Revenue Cycle.
  • Implements the compliance program through engagement with compliance subcommittees, leadership, operational staff, and affiliates (employed and/or contracted).
  • Works collaboratively on program components, standards, goals, resources, training, monitoring, reporting and team building efforts to align the compliance program with emerging internal and external expectations and requirements.
  • Serves as the official compliance program representative for the North Carolina location at internal and external meetings, presentations, and subcommittee/taskforace activities as well as providing assistance and/or informaiton on program elements
  • Assists in the identification of emerging risk areas and to oversee and conduct investigations, development and maintenance of policies and procedures and effective corrective action plans.
  • Develops educational content for compliance and trending of non-compliant activities to enhance compliance proficiency and competency, understanding of standards and the consequences of non-compliance.  Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging compliance challenges among affected parties and entities
  • Assists in the implementation, data collection, analysis and reporting of Conflicts of Interest and other required reporting to governance and leadership to support accurate and efficicent reporting of program efforts.
  • Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking

Qualifications - Minimum

  • Three to five years of in-depth experience within healthcare operations, law, and compliance programs either from a consulting perspective or as an employee/manager.
  • Demonstrated working knowledge of Medicare and Medicaid, Insurance Managed Care including documentation, coding, reimbursement methodologies, as well as extensive familiarity with Department of Health and Human Services Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS) rules, regulations and compliance guidance
  • Excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations. Ability to take major strategic objectives and break them down into meaningful action steps.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.