Job Description

Position Purpose: This position leads Steward Health Care Network (SHCN)'s compliance and privacy audit functions which include assuring business practices conform to federal, state, and local laws, regulations, and policies. Plans, coordinates, and manages audits and monitoring activities. Communicates the results of audits effectively, providing meaningful recommendations and feedback to management to strengthen the compliance culture of the organization. Works cooperatively with the organization’s compliance leadership, other auditors (internally/externally), and operational departments to ensure the timely completion of audits and the development of corrective action plans. Key activities include:

  • Assists the VP, Compliance and Privacy Officer and other relevant personnel in the process of assessing organizational compliance risk. Based on the annual and ongoing risk assessments, an annual compliance and privacy audit plan is developed which appropriately allocates audit resources to the areas of greatest compliance risk to the organization. Coordinates, plans, and executes audits by working with managers and appropriate staff to develop audit programs that document, assess, and monitor compliance with applicable requirements.
  • Conducts and/or directs auditing and monitoring compliance activities in accordance with compliance and privacy program standards, policies, and procedures. Reviews and ensures compliance with federal and state regulations imposed by government agencies, governmental contracts, and others. Advises on audit controls for internal processes ensuring appropriate measures are in place for accurate, complete, and compliant programs throughout SHCN. Proactively identifies areas throughout SHCN where there may be opportunity to mitigate risk and responds accordingly in a timely fashion, including encouraging local reporting of potential issues.
  • Communicates the audit plan and process so those being audited understand the requirements and expectations. Listens effectively throughout the audit process in order to understand. Communicates results through reports and exit conferences that strengthen the effectiveness of the compliance and privacy program. Facilitates and/or provides training as required to correct problems identified during audits. Assists stakeholders in the development of corrective action plans based on audit results and conducts follow up audits where needed.
  • Oversees the thorough documentation of all compliance and privacy audit related activities for SHCN to ensure compliance with federally-mandated reporting requirements. Ensures reporting requirements are maintained in a timely and accurate fashion for the system, including the resolution of each audit issue identified and closed. Reports on matters of business ethics, legal compliance, and operations of the program. With minimal supervision, is responsible for writing any and all related documents, reports, and executive and board presentations. Able to provide professional presentations, training sessions, reports and updates to board members, committees, and executive leaders.
  • Coordinates and manages externally contracted audits as needed to assure completion of the annual compliance and privacy audit work plan. Provides initial education to external auditors to ensure their understanding and adherence to SHCN compliance and privacy audit standard operating processes and related policies and procedures. Provides quality review to ensure reliability and accuracy of the audit services completed by external contracted audit groups.
  • Supports compliance and privacy program leadership including providing ongoing support in the development of specific goals and objectives. This position also acts as a resource to compliance management as needed or requested to address and resolve compliance- and privacy-related issues. Participates in various committee meetings at appropriate levels based on the need and direction of the VP, Compliance and Privacy Officer.
  • Maintains a current awareness of compliance- and privacy-related laws and regulations, keeping abreast of current changes that may affect health care systems through personal initiative, seminars, training programs, and peer contact.
  • This position supervises audit staff. This includes directing human resources actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training and personnel evaluations.

Education:

  • Bachelor’s degree (health care administration, business administration or another relevant field). Master’s degree preferred.

Years of Experience:

  • 3+ years health care managerial experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation of resources preferred
  • 5+ years applicable health care compliance, audit, analytical, or equivalent experience preferred
  • Experience conducting audits in the health care industry
  • Certified in Healthcare Compliance (CHC) and/or Certified in Healthcare Privacy Compliance (CHPC) preferred
  • Other certifications a plus: Accredited Healthcare Fraud Investigator (AHFI); Certified Fraud Examiner (CFE); medical coding [Certified Coding Specialist (CCS), Certified Professional Coder (CPC)]; or Certified Fraud Specialist (CFS).

Specialized Knowledge:

  • Knowledge of healthcare regulatory environment and skills in researching state and federal laws, rules, and regulations, particularly related to Medicare, Medicaid, and ACOs
  • Knowledge of standard audit protocols
  • Excellent analytic and problem-solving skills to process auditing and monitoring reports, identify compliance risks and prioritize recommendations
  • Excellent interpersonal, collaboration, communication and presentation skills essential

Application Instructions

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