Health System Specialist (Compliance and Business Integrity Officer)

Department of Veterans Affairs•San Diego, CA

45d•Onsite

About The Position

This position is located in the Department of Veterans Affairs (VA), Veterans Health Administration (VHA), San Diego VA Medical Center, in the Office of the Director. VHA's Compliance and Business Integrity (CBI) Program was established by the Under Secretary for Health in alignment with industry standards and trends to provide oversight to the VHA revenue cycle financial and business operations. The primary purpose of this position is to provide support to health care management officials by analyzing, evaluating, advising on and/or coordinating health care delivery systems and operations. The positions renders advice on operational policies and assures these policies and assures these policies are coordinated with, and in support of, field operations. Dramatic changes in VHA's business practices such as expansion of revenue cycle financial transactional activities, expansion of purchased care activity from non-VHA industry providers, and HHS OIG-defined health care industry oversight expectations, provided the primary impetus for implementing a standardized internal compliance program. The Compliance Officer serves as a role model for ethical behavior and promotes an awareness of moral principles consistent with the mission, vision and values of the organization and those required by federal law. Duties include but are not limited to: The incumbent functions as the primary liaison to multiple staff offices and serves as the conduit for information flow and management of assignments between such offices. Monitors and manages incoming actions and requests from initial receipt to completion and closeout. Analyzes the subject matter of incoming information for appropriate distribution to offices internal and external to the office. The Compliance Officer provides guidance and counsel on incorporating compliance related activities into operations areas. It is the incumbent's responsibility to instill the elements of the Office of Inspector General's model compliance plan into the VHA Compliance program. Distribute written policies and procedures that promote commitment to compliance and address specific areas of potential fraud, such as billing, collections, and coding. Performs an annual system wide prioritized risk assessment, develops and/or provides effective education and training programs for all affected employees to mitigate identified risks, develops and/or performs auditing and monitoring of identified risk areas, including newly identified risks throughout the year; assists service lines departments in developing appropriate monitoring and auditing processes that mirror facility goals. Maintenance of a process, such as a helpline, to receive complaints, and the adoption of procedures to protect the anonymity of complainants. Maintains high visibility and an open-door policy to encourage employees to report potential compliance issues. Conducts investigation and remediation of system problems identified through the helpline, employee and patient communications, and interaction with professional counterparts. Develops policies addressing the non-employment or retention of sanctioned individuals. Responds and takes appropriate action to allegations of improper/illegal activities and regulations, or federal health care program requirements. Develops, coordinates and/or conducts audits and/or other evaluation techniques to monitor compliance and to assist in the reduction of identified problem areas. Reviews periodic reports with senior management detailing compliance initiatives throughout the year and recommends changes and improvements to the VA San Diego CBI program and operational compliance related activities. Analyzes audit results, develops educational tools to address audit findings, and recommends system changes, as appropriate. Manages and coordinates of all online communication tools such as assigned intranet, websites, internal SharePoint website collection, and other related informational tools in consultation with communication specialists. Assures compliance with all applicable policies, and development and maintenance of internal management processes related to these online tools.

Responsibilities

Functions as the primary liaison to multiple staff offices and serves as the conduit for information flow and management of assignments between such offices.
Monitors and manages incoming actions and requests from initial receipt to completion and closeout.
Analyzes the subject matter of incoming information for appropriate distribution to offices internal and external to the office.
Provides guidance and counsel on incorporating compliance related activities into operations areas.
Instills the elements of the Office of Inspector General's model compliance plan into the VHA Compliance program.
Distributes written policies and procedures that promote commitment to compliance and address specific areas of potential fraud, such as billing, collections, and coding.
Performs an annual system wide prioritized risk assessment.
Develops and/or provides effective education and training programs for all affected employees to mitigate identified risks.
Develops and/or performs auditing and monitoring of identified risk areas, including newly identified risks throughout the year.
Assists service lines departments in developing appropriate monitoring and auditing processes that mirror facility goals.
Maintains a process, such as a helpline, to receive complaints, and the adoption of procedures to protect the anonymity of complainants.
Maintains high visibility and an open-door policy to encourage employees to report potential compliance issues.
Conducts investigation and remediation of system problems identified through the helpline, employee and patient communications, and interaction with professional counterparts.
Develops policies addressing the non-employment or retention of sanctioned individuals.
Responds and takes appropriate action to allegations of improper/illegal activities and regulations, or federal health care program requirements.
Develops, coordinates and/or conducts audits and/or other evaluation techniques to monitor compliance and to assist in the reduction of identified problem areas.
Reviews periodic reports with senior management detailing compliance initiatives throughout the year and recommends changes and improvements to the VA San Diego CBI program and operational compliance related activities.
Analyzes audit results, develops educational tools to address audit findings, and recommends system changes, as appropriate.
Manages and coordinates of all online communication tools such as assigned intranet, websites, internal SharePoint website collection, and other related informational tools in consultation with communication specialists.
Assures compliance with all applicable policies, and development and maintenance of internal management processes related to these online tools.