Manager of Corporate Responsibility, Audits and Investigations
: Job Details :

All the benefits and perks you need for you and your family:

* Benefits from Day One

* Paid Days Off from Day One

* Student Loan Repayment Program

* Career Development

* Whole Person Wellbeing Resources

* Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time

The role you'll contribute:

The Manager of Corporate Responsibility, Audits and Investigations, supports the Executive Director for Audits & Investigations to provide direction and oversight of systemwide monitoring and auditing activities that support the organizational Corporate Responsibility Program. As part of the Corporate Responsibility team, the Manager will be responsible for supporting the creation and implementation of the systemwide auditing and monitoring activities for the hospitals, physician groups, post-acute, population health, pharmacy, academic, research and clinical settings, utilizing a risk-based and regulatory approach. In addition to audit development, the Manager will be responsible for reviewing internal and external audit activities to ensure that systemwide risks are identified and responded to. The Manager will also serve as a substantive resource on the performance of investigations, including providing guidance on best practices and establishing investigational standards. The Manager will administer the system's incident reporting system, including triaging and following up on Guideline calls. The Manager will also be responsible for performing certain auditing and monitoring activities and investigations to support regional and corporate efforts.

The value you'll bring to the team:

* Monitoring and Auditing

o Annual Monitoring and Auditing Plan

Responsible for supporting the development and implementation of the systemwide Monitoring and Auditing (M&A) plan on an annual basis through the assessment of risks and input from systemwide stakeholders.

Responsible for developing audits to support the system's M&A efforts.

Responsible for communication of M&A expectations and standards to the Regional Corporate Responsibility Officers (RCROs) to ensure consistent and high-quality audit activities.

Responsible for evaluating audit activities, providing feedback and helping to assess institutional risk.

Responsible for reviewing and analyzing all audit findings and data from the M&A plan and providing concise, clear, and informative results and reports to regional and corporate leadership.

o On-going or Ad-Hoc Auditing/Monitoring Activities

Perform high-risk or as-needed audits on behalf of the organization.

Oversee the Exclusion Monitoring process including reporting and responding to and identified exclusion risks.

* Risk-Assessment and Regulatory Oversight

o Responsible for monitoring the regulatory environment and assessing institutional risks and inform necessary audit and investigation activities.

o Develop and perform an annual compliance risk assessment to identify perceived and actual institutional compliance risks.

o Monitor key regulatory changes and/or activities impacting health care to inform M&A activities.

* Investigations

o As directed by the Executive Director, perform high-risk investigations in a confidential and professional manner.

o Conduct data analysis and interviews to inform the investigative process.

o Perform a detailed analysis of investigative findings and summarize these findings in an investigative report.

o Support regional and corporate investigative efforts by being a subject matter expert.

o Create and establishing investigative standards and procedures to support investigation efforts across the organization.

* Regulatory and Data Analysis

o Interprets regulatory compliance policies and regulations.

o Ability to define problems, collect and validate data, establish facts, and draw conclusions.

o Interpret data and analyze results using statistical techniques.

o Acquire data from multiple data sources to review trends and support audit and investigative activities.

* Responsible for performing, managing, and executing other duties as assigned

* Strong working knowledge of computers.

* Strong oral and written communication skills.

* Strong knowledge of healthcare compliance and regulations including: the Office of Inspector General (OIG) Compliance Guidance, the Federal False Claims Act, the Federal Anti-kickback Statute, Stark Law and HIPAA.

* Basic knowledge of Medicare and third-party payer coding and billing regulations.

* Experience using word and excel platforms.

* Strong ability to assess, interpret and report data.

* Ability to conduct and supervise audits and investigations and document findings.

* Ability to evaluate audit and investigation findings to determine compliance with policy and regulations.

* Basic database management and administration, such as excel.

* Organizational and planning skills as well as the ability to handle multiple tasks simultaneously

* Ability to operate successfully in a constantly changing, fast-paced environment

* Ability to maintain a high level of confidentiality.

Qualifications

The expertise and experiences you'll need to succeed :

EDUCATION AND EXPERIENCE REQUIRED:

* Bachelor's degree in relevant field

* Minimum five years health care compliance experience.

EDUCATION AND EXPERIENCE PREFERRED:

* Masters or higher-level degree in related field

LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:

* Certification in Health Care Compliance or certification eligible, and certification obtained within first year

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Compliance

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 - Day

Req ID: 24038834

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.