Alternate Solutions Health Network hiring Compliance Manager in Kettering, OH | LinkedIn (2024)

This position will work out of our office in Kettering, OH - standard business hours.

SUMMARY:

The Manager of Compliance will be responsible for supporting the organization in efforts to adhere to applicable laws, regulations, and industry standards governing the home health and hospice space. This role is a key member of the Compliance Program as they promote compliance awareness, monitor organizational activity, and collaborate with key leaders and stakeholders to identify and mitigate risk and non-compliance.

QUALIFICATIONS:

Education/Experience:

• Associate degree in related field or equivalent experience required. RN, LPN, PT, PTA, COTA preferred.
• 5+ years of Homecare and/or Hospice experience required.
• 3+ years of healthcare compliance required.
• Certification in Healthcare Compliance (CHC), Compliance and Ethics Professional (CCEP), and/or Healthcare Privacy Compliance (CHPC) preferred.
• Proficiency in Microsoft Office Suite products (include Word, Outlook, Excel, PowerPoint, Teams, SharePoint).

Technical Skills:

• Ability to lead a diverse team of individual contributors within the compliance department to support employee growth, strong team dynamics, and compliance program success.
• Strong understanding of risk management and mitigation strategies.
• Ability to analyze large datasets, including patient records, billing information, and other pertinent details to identify patterns, discrepancies, and potential areas of concern.
• A deep understanding of healthcare regulations particularly those related to home health and hospice services, such as Medicare and Medicaid guidelines, HIPAA (Health Insurances Portability and Accountability Act) Anti-Kickback Statues, and Fraud, Waste and Abuse.
• Familiarity with medical coding systems (ICD-10) and billing processes.
• Proficiency in using electronic health record (EHR) systems and other health information technology tools commonly used in home health and hospice settings.
• Knowledgeable of audit principles and methodologies to conduct thorough compliance audits. This includes understanding audit procedures, documentation requirements, and reporting standards.
• Strong presentation skills in both in-person and virtual meeting forums.
• Clear and effective communication capabilities to convey complex messages, concepts, and interpretations.

Other Skills:

• Indisputably high ethical standards, with a commitment to maintaining confidentiality.
• The ability to think critically and identify potential compliance issues, as well as identify potential solutions to address them.
• A keen eye for detail for identifying discrepancies or irregularities in documentation, coding, billing, or other processes associated with assigned tasks.
• Strong organizational skills and the ability to keep details and accurate records, notes, and findings related to assigned audits and tasks.
• Capable of working in both independent role to complete assigned tasks while able to positively contribute to the department and company team culture.

ESSENTIAL FUNCTIONS / RESPONSIBILITIES

• Supports the Compliance Auditors in their day-to-day assignments, professional growth and development while maintaining a positive and healthy working environment.
• Assists in the training of compliance team members and agency/company employees in matters relating to compliance topics and trends.
• Oversees, supports, and completes detailed audits and reviews as assigned by Compliance Department leadership or the Corporate Compliance Committee to ensure audits are completed accurately and timely.
• Supports and oversees the internal third-party payer Additional Documentation Requests (ADRs) process to ensure timely response with a high standard of accuracy and quality.
• Provides oversight to the vendor, physician, and clinician screening processes.
• Supports and oversees the review and maintenance of company policy. Supports processes to ensure the organization of and access to the policies for all employees via the dedicated policy platform.
• Assists in and completes regulatory interpretive reviews, investigations, and data collection to support business best practice decision making and ongoing adherence to applicable rules and regulations.
• Assists in ongoing risk assessment monitoring and annual risk assessment initiatives.
• Responds to and supports organizational staff and leadership with compliance related matters.
• Maintains current knowledge of applicable Federal and state rules and regulations.
• Adheres to ASHN policies, procedures, and Code of Conduct and Business Ethics
• Other duties as assigned.