Executive Director & Clinical Compliance Officer

Title: Executive Director & Clinical Compliance Officer  

Location: Midtown  

Org Unit: Compliance and Privacy Office 

Work Days: Monday-Friday 

Exemption Status: Exempt

Salary Range: $172,600.00 - $214,200.00  

*As required under NYC Human Rights Law Int 1208-2018 - Salary range for this role when Hired for NYC Offices 

Position Summary

Oversees the effectiveness, operation, administration, and management of the Clinical Compliance program. This includes focusing on professional fee billing compliance, research billing compliance, Release of Information (ROI) management, the Accountable Care Organization, and the adherence to regulatory requirements. The role encompasses strategic leadership, communication, collaboration, and investigation while maintaining the regulatory alignment of the program.

Job Responsibilities

• Provides strategic direction and oversight regarding all clinical compliance program matters.
• Oversight of compliance operations and audit workplans, monthly, quarterly, and annual required reports and presentations, and dissemination of clinical compliance information to all affected parties through a robust communication strategy. 
• Manages the preparation and presentation of executive summaries of audit and review results along with corrective action plans, and reports these to the Chief Compliance and Privacy Officer and Clinical Compliance Oversight Committee.
• Serves as the senior-level liaison representing the WCM clinical compliance program to all WCM Departments and across the tripartite system.
• Collaborates with strategic partners. Provides executive level assistance, advice, and guidance related to handling complex clinical compliance matters.
• Leads investigations or project steps within a broader project and have accountability for accomplishment of ongoing activities or objectives.
• Conduct data analysis and ensure consistent application of ethical business principles, WCM policies and procedures, and regulations related to clinical compliance subject matter.
• Proactively identify problem areas and gaps and addresses them appropriately.
• Stays abreast of technical coding guidelines and governmental and payer regulations to keep clinical compliance program current and to disseminate this information to clinical and compliance staff.
• Ensure that WCM clinical compliance program remains comprehensive and consistently meets CMS/OIG regulatory compliance requirements, as well as applicable Federal, State, and Local regulatory agency guidelines and laws.
• Oversees the management and supervision of staff development, staff performance, and clinical compliance team building. Leverage knowledge and skill set of all reporting positions to identify risk and effectively manage the compliance program.
• Oversees the development and lead the presentation of clinical compliance education programs.  Oversees Research Billing Compliance activities, ensuring adherence to regulations and effective management of audit plan, reports, and education materials.
• Oversees the Release of Information (ROI) Management processes, including compliance with regulatory requirements relating to timely and accurate release of records, amendments, restrictions, and accounting of disclosures.
• Perform other related duties as assigned.

Education

• Master's Degree in related field

Experience

• Requires 10 -15 years of progressively more responsible management experience in health care compliance related to risk identification and remediation, and audit programs for medical record documentation, coding, and revenue cycle integrity, and relevant laws and regulations (e.g., coding, billing, Medicare and Medicaid reimbursement, fraud and abuse laws, Medicare Conditions of Participation, the Stark and Anti-kickback statutes, HIPAA, FDA, DPH, and HHS-OCR) and enforcement to manage a regulatory compliance program. 

Knowledge, Skills and Abilities

• Strong leadership, communication, and collaboration skills.
• Requires knowledge of industry issues, managing complex projects, and Federal, State and Local regulatory agency guidelines and laws.

Licenses and Certifications

• Requires professional certification in a compliance related field of expertise, such as internal audit, fraud investigation, health care compliance, or healthcare information management, multispecialty professional fee coding and billing.
• Certification examples: RHIA Certified Professional Coder (CPC, CCS-P), Certified Hospital Coder (CCS- H) Certified Medical Compliance Officer (CMPO), Certified Professional Medical Auditor (CPMA), HCCA Compliance (CHC), etc.

Working Conditions/Physical Demands

 

 

 

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