Senior Regulatory Compliance Specialist

Company: Nuvance Health
Location: Danbury
Posted on: May 13, 2022

Job Description:

Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center, and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.Associate Regulatory Compliance OfficerSummaryThe Associate Compliance Officer position is a publicly-facing position that will need to independently engage in an effective, ethical, and appropriate fashion with various Nuvance Health stakeholders, including but not limited to, Nuvance Health employees, business affiliates, agents, patients, patient's family, and other Nuvance Health stakeholders and will be responsible, working under the supervision of the Special Associate Compliance Officer ("SACO"), for helping to effectuate key elements of an effective compliance program, including but not limited to: (i) the investigation of potential offenses, the development of corrective action plans in response to confirmed violations of the Nuvance Health Compliance and Ethics Program ("Compliance and Ethics Program" or "Program") and applicable law, as well as the mandatory reporting and refunding of any overpayments; (ii) the establishment of open lines of communication between the Compliance Office and all Nuvance Health Covered Individuals and other Nuvance Health stakeholders; (iii) the development of training and education for all affected Nuvance Health Covered Individuals; and (iv) the performance of compliance auditing and monitoring of Nuvance Health's Compliance and Ethics Program.Responsibilities1. Under the direction of the SACO, assisting with and conducting the investigation of potential offenses, and assisting with the development of corrective action plans in response to confirmed violations of the Compliance and Ethics Program and/or applicable law, as well as the mandatory reporting and refunding of any overpayments. Accountabilities in this area include the coordination and performance of internal investigations of varying degrees of complexity, as warranted, in response to compliance violations, problems, issues, and concerns related to fraud, waste, and abuse, and other compliance violations. Duties will include planning and conducting investigatory interviews independently and under the supervision of the SACO, drafting investigatory memoranda, and communicating investigatory findings to the appropriate stakeholders within Nuvance Health, including varying levels of senior leadership. A related duty is to assist in the development and monitoring of corrective action plans and associated reporting, as applicable, in response to potential and suspected compliance issues that have been confirmed.2. Responsible for, with coordination and oversight from the SACO, administering and maintaining processes for open lines of communication between the Compliance Office and all Nuvance Health Covered Individuals, which includes workforce members, business affiliates, agents, patients, patient's families, and other stakeholders. Main accountability is to maintain the Nuvance Health Confidential and Anonymous Compliance and Ethics Helpline and related database (i.e., Ethics Point), which entails maintaining case details and activities within the databases, including processing information, referring cases to other departments, exchanging correspondence with complaints through the Ethics Point platform; documenting the case file as necessary, and closing completed compliance investigations/cases in the system. Further accountability in this regard is to enhance the process, including providing user support, employee training, systematized monitoring, databaseenhancements, and improved compliance report interpretation. Related duties include: (i) regularly meeting with the SACO and other Compliance Office leadership to provide an update on the status of cases submitted to the Compliance Office by any modality, including Ethics Point, and ongoing investigations contained in same; and (ii) assisting with the creation of dashboards and reports for presentation to key Nuvance Health stakeholders, including the Audit & Compliance Committee of the Nuvance Health Board of Directors.3.Assisting the SACO in the performance of compliance auditing and monitoring and the development of internalcontrols to reduce compliance vulnerabilities focused on assessing Nuvance Health's compliance with statutory, regulatory, internal standards in the following risk areas: a) The Physician Self-Referral Law ("Star Law"); b) Anti-Kickback Statute; c) Environmental compliance; d) Mandatory reporting and overpayments, e) Deficits Reduction Act of 2005; f) Medicare Parts C & D Compliance/Training and Education; g) exclusionary authorities; h) Criminal Healthcare Fraud Statute; i) Civil Monetary Penalties Law; j) Federal and State False Claims Act; k) Whistleblower protection; l) Fraud, waste and abuse, m) Federal Healthcare Program and private payor requirements; n) other compliance items, as informed by OIG fraud alerts, work plan items, educational materials (including CMS Medicare Learning Network and other regulatory agency publications), regulatory advisories, and enforcement agreements issued by regulatory oversight bodies, and o) other risk areas identified by the SACO or other supervising compliance officer. Under the direction of the SACO, assisting with the performance of Organization-wide risk identification, assessment, scoring, and prioritization activities, which includes, without limitation, the development of a risk scoring table, Constantly monitor Nuvance Health's Compliance and Ethics Program Effectiveness including, for example (i) the development of an audit tool that shall serve as a means to perform an annual compliance program gap analysis; and (ii) the performance of an annual assessment of the Nuvance Health Compliance and Ethics Program's effectiveness. Assisting the SACO with the preparation of and independently preparing written memoranda, PowerPoint presentations, and dashboards, and other compliance metrics with regard to results of compliance auditing and monitoring of the Network-wide fraud, waste, and abuse prevention activities and Nuvance Health Compliance and Ethics Program assessment endeavors; (i) outline compliance efforts related thereto; and (ii) document the level of effectiveness of corresponding compliance initiatives to be presented to senior Nuvance Health leadership, including the members of the Audit and Compliance Committee of the Nuvance Health Board of Directors. Preparation will include providing accurate data review, analysis, interpretation, and reporting related to data-mining and trending audit findings to identify potential vulnerabilities and opportunities.4. Assisting the SACO with the development and implementation of Organization-wide training and education programs on (i) compliance issues such as fraud, waste, & abuse and related Federal and State laws, and as needed, other compliance areas (e.g. Provider-Based rules, billing requirements related to medical necessity, and patient notification requirements); (ii) the operation of the Nuvance Health Compliance and Ethics Program; and (iii) the expectations of all Nuvance Health workforce members, business affiliates, and agents under the Compliance and Ethics Program, including the potential consequences of noncompliance. Further, providing guidance and education to operational and clinical service departments regarding development and completion of any related annual department Work Plans consistent with the OIG Work Plan and service department identified areas of risk; to enhance educational programs, creating related reports in accordance with agreed-upon standards and quality measures in a timely manner to be communicated to the various operational and clinical service departments.5. Responsible for conducting a monthly screening of referring physicians, medical staff, employees, volunteers, students, trainees, board members, and vendors against all exclusion databases, as required by law, including, but not limited to, the U.S. Department of Health and Human Services Office of Inspector General List of Excluded Individuals/Entities (LEIE); U.S. General Services Administration System for Award Management (Sam) Excluded Entities List; the publicly available state-level Medicaid exclusions lists (or equivalent) for, at a minimum, Connecticut, New York, and Massachusetts; and other federal lists, including the Office of Foreign Asset Control, Specially Designated Nationals list maintained by the Department of Treasury, Office of Foreign Asset Control, and the OIG database containing a list of all violators of the Foreign Corrupt PracticesAct ("FCPA"). In the event, a match or potential match is found, responsible for investigating individuals' status and coordinating any overpayments, as necessary, in conjunction with the SACO.6. Working with the SACO, developing written policies and procedures, practices, and standards, to implement the Nuvance Health Corporate Compliance and Ethics Program consistent with: (i) any requirements that may be found under applicable Federal and State law; (ii) the corresponding principles set forth in the Department of Health and Human Services Office of the Inspector General ("OIG") 1998 (63 Fed. Reg. 8987) and 2005(Supplemental) Guidance to Hospitals (70 Fed. Reg. 4858) and the most current United States Sentencing Commission Guidelines Manual; and (ii) developing a fraud, waste, and abuse prevention program.7. Fulfilling all compliance responsibilities related to the position, and performing other duties as assigned.Other InformationThis position requires a minimum formal education of a Bachelor's Degree and a minimum of three years of job-related experience.Excellent analytical skills with the ability to compile and interpret complex data; analyze trends, problem solve. Significant knowledge and clear understanding of Compliance related federal healthcare regulations and guidelines, including but not limited to the fraud, waste, and abuse laws requirements that apply to healthcare entities, and significant knowledge in conducting investigations. Excellent oral and written communication skills; ability to interact with various levels of staff and management across the Nuvance Health, and other Nuvance Health stakeholders, including patients and patients' families. Capable of building relationships and gaining trust. Ability to develop, maintain and strengthen collaborative relationships with both internal and external stakeholders. Ability to prioritize workload and meet multiple conflicting deadlines, retaining composure, efficiency, and professionalism under pressure in particular in communicating with external agencies. Proficiency with Microsoft Excel, Word, PowerPoint, and any compliance-related databases and helpline tools.*Criteria Desired (Not Required): *. Ability to be flexible and adapt to new information, changing conditions, or unexpected obstacles. Experience with Complytrack, Cerner, and/or Soarian Financials preferred.Certification in (i) healthcare compliance ("CHC" designation) from the Compliance Certification Board within three (3) months of appointment (must be eligible to take the certification exam at the time of appointment) or (ii) compliance and ethics ("CCEP") designation from the Compliance Certification Board at the time of appointment; and (iii) fraud examination ("CFE" designation) from the Association of Certified Fraud Examiners within fifteen months of appointment.*Location: * The Summit at Danbury, CT*Work Type: * Full-Time*Standard Hours: * 40.00*FTE: * 1.000000*Work Schedule: * Day 8*Work Shift: * Monday through Friday (hybrid remote)*Org Unit: * 239*Department: * Corporate Compliance*Exempt: * Yes*Grade: * S12*Education: **Nonessential: ** Bachelor's Level Degree*Working conditions: **Nonessential: ** Some manual skills/motor coord & finger dexterity* Sedentary/light effort. May exert up to 10 lbs. forceEOE, including disability/vets.We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.NHTA1Job Type: Full-time

Keywords: Nuvance Health, Danbury , Senior Regulatory Compliance Specialist, Other , Danbury, Connecticut