Officer, Ethics & Compliance, Revenue Cycle

Sutter Health•Sacramento, CA

3d•$148,824 - $291,013•Hybrid

About The Position

Administers and provides oversight of the Sutter Health Ethics and Compliance Program, addresses risk related to business ethics and compliance requirements, and ensures all policies, processes, and practices adhere to expectations of the Federal Sentencing Guidelines, HHS Office of the Inspector General and the HHS Department of Justice. Manages the design and implementation of strategies, policies, processes, and tools that facilitate effective and efficient compliance practices, observe and report actual or potential violations, establish and track training requirements, and monitor the progress of corrective actions. Investigates and maintains documentation of ethics and compliance incidents and ensures timely reporting to government entities as required by law. Develops and conducts periodic risk assessments, monitors key elements of the Ethics & Compliance program, and ensures implementation of training programs for members of the affiliate's workforce and physicians. Ensures the alignment, standardization, and effectiveness of compliance activities across the affiliate, operating unit (OU), and system levels. Participates in the development and delivery of a training strategy that addresses both general and specific (role-based) compliance education needs, that provides up-to-date information on current legal, regulatory and Sutter Health policy requirements, and that builds awareness of the program, processes, and potential legal ramifications of noncompliance. Provides insights regarding regulatory changes, trends, areas for potential risk, and process gaps, and offers compliance guidance and reporting to senior management and governance boards.

Requirements

Expertise in managing an effective ethics and compliance program, including: infrastructure development; policy management; training; monitoring/auditing; conducting and documenting investigations; addressing and resolving violations, errors, and deficiencies; tracking corrective actions, performing risk assessments, and designing strategies to prevent future compliance problems.
Detailed understanding of healthcare compliance standards, compliance program development and assessment, relevant healthcare operational issues, business ethics and compliance risks and the knowledge to effectively manage those risks in a dynamic healthcare environment.
Comprehensive knowledge and understanding of current regulations that govern healthcare operations, including the California Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Insurance Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws, and licensure requirements, and quality standards.
In-depth knowledge of federal and state regulatory filing and reporting systems: national Association of Insurance Commissioners (NAIC) System for Electronic Rate and Form Filing; California Department of Managed Healthcare (DMHC) eFiling web portal; Centers for Medicare and Medicaid Services (CMS) Enterprise Portal; Health Insurance Oversight System (HIOS) Portal; Rates and Benefits Information Systems (RBIS).
Well versed in current and emerging business ethics and compliance topics, project management methodologies and tools, resource management and change management techniques.
Working knowledge of other disciplines outside own area of expertise, including business planning, clinical disciplines, human resources, finance, clinical and financial auditing, and information technology.
Strong organizational skills with an excellent understanding of team building and organizational dynamics, including creative problem identification and resolution, conceptualization, and contingency thinking skills.
Advanced project management skills, including the ability to facilitate and manage multiple complex projects simultaneously while efficiently and effectively achieving objectives.
Superior attention to detail, superior analytical and strategic planning skills with the ability to identify potential issues/risks/trend, analyze data, provide insights to staff and affiliates, and recommend actions to resolve or minimize the impact.
Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex legal and regulatory requirements directives, ideas, and concepts clearly and professionally to diverse audiences and all levels of internal/external leadership.
Competency in Microsoft Office suite (Word, Excel, PowerPoint), including a working knowledge of data management to interpret information and track results, and internet-based legal and regulatory research.
Ability to translate complex legal and regulatory requirements into lay terms and provide cogent advice to senior management regarding the impact of compliance enforcement, legislation and regulations on affiliate business strategies, and its not-for-profit mission.
Ability to convert a vision into a strategic and actionable plan with clear ethics and compliance goals and objectives.
Ability to adapt to changing or challenging initiatives while developing new ideas and approaches aimed at improving results.
Ability to foster a collaborative environment, to influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority.
Ability to maintain strict confidentiality of all compliance and risk management data, and ensure the privacy of each patient’s protected health information (PHI).
Ability to build and maintain collaborative relationships with peers, other departments, stakeholders, consultants, government agencies, and external organizations to achieve regulatory and accreditation compliance.

Nice To Haves

Coding, Billing and Documentation.
RHIA, RHIT, CCS, CDIP, CCDS or CRD preferred.
Epic experience.
CHC-Certified in Healthcare Compliance (except for Research support)
Research Support: CHRC-Certificate in Healthcare Research Compliance

Responsibilities

Administers and provides oversight of the Sutter Health Ethics and Compliance Program.
Addresses risk related to business ethics and compliance requirements.
Ensures all policies, processes, and practices adhere to expectations of the Federal Sentencing Guidelines, HHS Office of the Inspector General and the HHS Department of Justice.
Manages the design and implementation of strategies, policies, processes, and tools that facilitate effective and efficient compliance practices.
Observes and reports actual or potential violations.
Establishes and tracks training requirements.
Monitors the progress of corrective actions.
Investigates and maintains documentation of ethics and compliance incidents.
Ensures timely reporting to government entities as required by law.
Develops and conducts periodic risk assessments.
Monitors key elements of the Ethics & Compliance program.
Ensures implementation of training programs for members of the affiliate's workforce and physicians.
Ensures the alignment, standardization, and effectiveness of compliance activities across the affiliate, operating unit (OU), and system levels.
Participates in the development and delivery of a training strategy that addresses both general and specific (role-based) compliance education needs.
Provides up-to-date information on current legal, regulatory and Sutter Health policy requirements.
Builds awareness of the program, processes, and potential legal ramifications of noncompliance.
Provides insights regarding regulatory changes, trends, areas for potential risk, and process gaps.
Offers compliance guidance and reporting to senior management and governance boards.