Ethics & Compliance Consultant III

Sutter Health•Santa Rosa, NM

11d•$145,205 - $217,797•Onsite

About The Position

Works to assure compliance with Physician Self-Referral laws, Anti-Kickback statues, fraud, waste and abuse laws, and other compliance laws and the organization's policies and procedures. Works with and serves in the absence of the compliance officer in overseeing, coordinating, implementing, administering, and evaluating the Sutter Health ethics and compliance program at assigned entity(s). Collaborates with entity organizational staff, ethics and compliance staff, and legal & risk services team members regarding changes in federal and state laws and regulations for healthcare providers and the organization's policies and procedures. Plans, executes, and leads a variety of regulatory compliance based projects. Leads in the day-to-day management of ethics and compliance incident response process. Partners with the compliance officer to conduct and report on internal investigations and compliance risk assessments and assists with the development of compliance policies and procedures. Serves as a resource person to perform the various activities of the ethics and compliance program and includes monitoring, investigation coordination, data quality assurance, training and education, and managing any confidential reporting received via mailbox or phone messaging. This position will perform trending, analysis and metric reporting related to ethics and compliance incidents and make recommendations for control implementation, education opportunities and remediation.

Requirements

Equivalent experience will be accepted in lieu of the required degree or diploma.
Bachelor's degree in Business Administration or related field.
CHC-Certified in Healthcare Compliance within 1 Year of hire OR CHRC-Certified in Healthcare Research Compliance within 1 year of hire OR Juris Doctorate within 1 year of hire.
5 years of recent experience.
In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting and documenting investigations, addressing violations, tracking corrective actions, and training.
In-depth knowledge of healthcare clinical operations, hospital revenue cycle systems, and healthcare billing and coding requirements.
Working knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources.
Familiarity with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws.
Exceptional attention to detail with excellent time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines.
Strong business acumen and exceptional analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.
Excellent written/verbal communication, interpersonal, and presentation skills with the ability to translate complex legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences.
Proficient computer skills, including advance competency in Microsoft Office Suite (Word, Excel, Visio, Project, and PowerPoint), SAP SE Crystal Reporting, and other software.
Ability to work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established timeframes and government regulations.

Nice To Haves

Support the following locations: CPMC, Mills Peninsula, Lakeside, Santa Rosa and other locations as assigned.

Responsibilities

Overseeing, coordinating, implementing, administering, and evaluating the Sutter Health ethics and compliance program at assigned entity(s).
Collaborating with entity organizational staff, ethics and compliance staff, and legal & risk services team members regarding changes in federal and state laws and regulations for healthcare providers and the organization's policies and procedures.
Planning, executing, and leading a variety of regulatory compliance based projects.
Leading in the day-to-day management of ethics and compliance incident response process.
Conducting and reporting on internal investigations and compliance risk assessments.
Assisting with the development of compliance policies and procedures.
Serving as a resource person to perform the various activities of the ethics and compliance program including monitoring, investigation coordination, data quality assurance, training and education, and managing any confidential reporting received via mailbox or phone messaging.
Performing trending, analysis and metric reporting related to ethics and compliance incidents.
Making recommendations for control implementation, education opportunities and remediation.
Managing and organizing large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.
Identifying potential concerns and compliance issues and then assisting in the development and implementation of actionable recommendations or process improvements to resolve the problem.
Advising management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations.
Abstracting information from medical records, reports, chart entries, related patient documentation, and interviews while conducting audits and investigations.
Directing, prioritizing, and driving multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget.
Making informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.
Fostering an open and collaborative environment that invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.
Maintaining strict confidentiality of sensitive material (compliance and risk management data) and ensuring the privacy of each patient’s protected health information (PHI).
Working effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.
Building collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.