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
Click
here to apply!
|