Vice President | Compliance & Privacy

Gundersen Health System•Onalaska, WI

13d•Onsite

About The Position

Reporting to the Co-Chief Legal Officer, this role leads and assumes management responsibility for the structure, development, implementation and operation of Emplify Health’s enterprise Compliance and Privacy Programs to ensure compliance with state and federal laws, regulations, and policies to help prevent fraud and abuse. The VP, Compliance & Privacy serves as a trusted advisor to management and board, offering guidance and practical solutions to complex regulatory compliance challenges. Provides periodic reporting to the enterprise Board. The VP, Compliance & Privacy will also coordinate with other key stakeholders involved in enterprise risk management. The VP formulates and enforces policy, consistent with Emplify Health standards.

Requirements

REQUIRED: Master's or advanced degree in Healthcare/Hospital Administration, Law, or a related field.
REQUIRED: Healthcare Compliance Certified (CHC) and Healthcare Privacy Compliance Certified (CHPC) by the Health Care Compliance Association.
REQUIRED: Minimum 10 years of compliance experience in health insurance or healthcare administration.
Minimum of 5 years of progressive leadership experience in a healthcare system.
Specific knowledge and experience of health care corporate compliance program and privacy program standards and requirements, including oversight and experience of a conflict of interest management program; Stark; Anti-kickback Statute; Civil Monetary Penalties Law; EMTALA; HIPAA; Fraud Waste and Abuse; No Surprises Act and similar state laws.

Nice To Haves

DESIRED: Healthcare Research Compliance Certified (CHRC) by the Health Care Compliance Association.
DESIRED: Expertise and experience in clinical research, data security, revenue cycle.
Specific knowledge and experience of regulations associated with specific provider types such as: Acute Care Hospitals, Critical Access Hospitals, Rural Health Clinics, emergency transport, behavioral health, skilled nursing facilities, renal dialysis, home health and DMEPOS.

Responsibilities

Creation and implementation of comprehensive compliance and privacy strategies, risk assessments and detailed audit plans for the Enterprise.
Oversee development and implementation of compliance and privacy policies, procedures, processes, training, and best practices to promote compliance with applicable laws and regulations.
Oversee compliance investigations to ensure they are conducted timely and effectively and that corrective action if applicable is initiated and sustained.
Provide influential, collaborative leadership and guidance to Emplify executive leadership and operations on compliance, privacy, ethics and regulatory issues to reduce risk and enable strategic business objectives.
Develop and maintain strong stakeholder relationships across the business to support compliance and privacy initiatives.
Partner with Emplify leadership to further enhance culture of compliance throughout the Enterprise.
Collaborate with various departments, subject matter experts, and external partners to ensure compliant solutions for business needs.
Manage a team of compliance and privacy professionals dedicated to ethical and compliant business practices.
Oversee development and delivery of effective compliance and privacy programs designed to detect, prevent, and address issues across the Enterprise.
Ensures the Enterprise operates a Compliance Program that includes the 7 elements of a Compliance Program as outlined by the Office of Inspector General.
Ensures detailed records are maintained to document compliance and privacy research, issues, audits, investigations, efforts, corrective actions and informed decision-making.
Continuously monitor legal and regulatory environments affecting the Enterprise.
Oversees monthly background screening against OFAC, SAM, EPLS, OIG and applicable state Medicaid databases
Oversee and support communications, issue resolution, and overall compliance engagement with regulators in partnership with operations, legal and business teams as such matters relate to Compliance Program and Privacy Program activities.
Oversee collaboration with operations, and other functional areas to review, analyze and develop/oversee initial implementation project plans and/or corrective action plans to ensure compliance with new or existing laws and regulations.
Oversees the Conflict of Interest Management program for the Enterprise.
Reviews grant applications for compliance with grant requirements.
Responsible for Compliance and Privacy budget development.