Professional Compliance Program Manager II

Seattle Children's • Seattle, WA

2d • Hybrid

About The Position

Under the direction of the Professional Compliance Officer (CO), this role will develop and oversee key elements of the professional compliance program for Seattle Children's employed and contracted providers, including the Seattle Children's Physician Network (SCPCN). The role involves designing, implementing, and managing the SC professional compliance program to ensure that SC providers submitting professional claims adhere to applicable laws, contractual obligations, internal policies, and ethical standards. This includes identifying and leading special compliance projects or investigations related to coding, billing, reimbursement, and other regulatory matters. The position contributes to the annual compliance work plan, advises the CO on billing and coding matters, and conducts research and analysis to support compliance decisions. This includes reviewing industry standards and facilitating consultations for policy development or process improvements. Key operational functions include managing all components of the SC professional compliance program, while personally performing some components, such as annual audit, ad hoc investigations, as directed by the CO. Additional duties include tracking resolutions, identifying trends in compliance issues, and participating in identification of solutions and system changes. The position also tracks OIG work plan issues and CMS billing compliance initiatives, advising the CO on their impact. The role may include presenting at board level meetings, large group training, and in interactions with the payer community. This position develops goals, plans, and metrics, ensuring effective communication and implementation of initiatives. Represent the Professional Compliance Officer as needed. SERIES CONCEPT: A program is a specialized area with specific complex components and discrete tasks which distinguish it from the main body of the organization. There is a defined plan to accomplish a particular objective with elements and scope that distinguish it from the usual scope and responsibilities of a department or functional area. The specialized tasks involve interpretation of policies, procedures and regulations, independent functioning and public contact. A program typically has a long-term focus with an expectation that the plan/program will serve or impact on-going needs or goals. The primary responsibilities and accountabilities are typically transferable from one program to another. The performance of administrative tasks are in support of the individual's performance specific to the program. This is a hybrid remote position and must be based in Washington state.

Requirements

• Bachelor's degree in a related field or equivalent combination of education and extensive work experience
• Five years’ experience in healthcare compliance or with progressive responsibility.
• Four years of experience in healthcare management or a supervisory role working with cross-functional teams, including analysis and reporting to deliver improved outcomes
• Demonstrated experience leading projects, teams, and/or system improvements
• Expert understanding of Federal and State healthcare statutes, regulations, and requirements for Federal healthcare programs, particularly as they relate to professional fee billing, including Teaching Physician Guidelines.
• Experience preparing and presenting information to a variety of roles, including providers, managers, and senior leaders in small or large group settings.
• Current Coding and/or Medical Records Certification (acceptable credentials include CCS-P, CPC)

Nice To Haves

• Certification in Health Care Compliance (CHC)

Responsibilities

• Designing, implementing, and managing the SC professional compliance program
• Identifying and leading special compliance projects or investigations related to coding, billing, reimbursement, and other regulatory matters
• Contributing to the annual compliance work plan
• Advising the CO on billing and coding matters
• Conducting research and analysis to support compliance decisions
• Managing all components of the SC professional compliance program
• Tracking resolutions, identifying trends in compliance issues, and participating in identification of solutions and system changes
• Tracking OIG work plan issues and CMS billing compliance initiatives, advising the CO on their impact
• Presenting at board level meetings, large group training, and in interactions with the payer community
• Developing goals, plans, and metrics, ensuring effective communication and implementation of initiatives
• Representing the Professional Compliance Officer as needed

Benefits

• Seattle Children’s offers a generous benefit package, including medical, dental, and vision plans, 403(b), life insurance, paid time off, tuition reimbursement, and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees