Director of Compliance and Risk Management

MAJOR FUNCTION

The Director of Compliance and Risk Management is responsible for ensuring compliance with the applicable regulations and requirements of external entities such as local health departments, the New Jersey Department of Health, the Federal Office of Inspector General (OIG), the Health Resource and Service Administration (HRSA), and the Joint Commission through oversight and support of key areas such as provider credentialing, risk management and time and effort reporting.

ESSENTIAL FUNCTIONS

§  Oversees and coordinates risk management initiatives and activities in compliance with HJAHC’s CQPRM plan; prepares quarterly and annual Risk Assessment Reports and annual FTCA submissions

§  Collaborate with senior leadership to ensure compliance with external regulatory bodies such as HRSA, FTCA, Joint Commission, and the National Committee for Quality Assurance

§  Works with senior leadership on development, implementation and maintenance of a Risk Management training plan for both staff onboarding and annual re-training

§  Responsible for oversight of credentialing and privileging policies and procedures

§  Conducts credentialing audits and implements performance improvement and/or new initiatives as required to reduce errors and improve processes and performance

§  Collaborates with the Directors of HR and Revenue Cycle Management to ensure efficient, comprehensive enrollment and re-enrollment of LIPs

§  Supports HR and Finance team to ensure compliant Time and Effort reporting for staff funded by grants

§  Works with the Director of Revenue Cycle Management and key Finance team members to track patient care revenue, minimize missing slips and monitor sustainability of services and staff

§  Monitors billing and coding practices in conjunction with the Finance team and Clinical leadership; trains and retrains LIPs as needed

§  Monitor regulatory sources to stay informed of rapidly changing rules and regulations that relate to credentialing processes

ADDITIONAL RESPONSIBILITIES:

·       Performs other duties and assumes other responsibilities as apparent and/or as assigned by Chief Operating Officer. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Requirements

EDUCATION & EXPERIENCE:

·       Undergraduate degree in a health care or business discipline

·       Graduate degree or additional relevant training is preferred

·       Three to five years’ experience in the areas of credentialing,

·       Preferred minimum of 2 (two) years supervisory experience

·       Demonstrated leadership abilities within an interdisciplinary, culturally diverse staff team

·       Demonstrated leadership experience in change management

·       Minimum of 2 to 3 years in a medical office setting.

LICENSURE AND/OR CERTIFICATIONS:

·       Must hold current certification in Basic Life Support.

KNOWLEDGE, SKILLS, ABILITIES AND OTHER (KSAO’s)

·       Ability to write reports, business correspondence and procedure manuals. 

·       Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.

·       Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions and decimals.  Ability to compute rate, ratio and percent and to draw and interpret bar graphs.

·       Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety    of instructions furnished in written, oral, diagram or schedule form.

·       Effective organizational & time management skills

·       Strong work ethic, a commitment to excellence and self-motivated

·       Accountable to the Chief Operating Officer for all phases of activities

PHYSICAL & WORK REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This position requires the manual dexterity sufficient to operate phones, computers and other office equipment.  The position requires the physical ability to kneel, bend, and perform light lifting.  This person must have the ability to write and speak clearly using the English language to convey information and be able to hear at normal speaking levels both in person and over the telephone.  Specific vision abilities required by this job include close vision, depth perception and the ability to adjust focus.  Generally, the working conditions are good with little or no exposure to extremes in health, safety hazards and/or hazardous materials.