The Regional Manager-Corporate Responsibility in collaboration with the Regional Director-Corporate Responsibility will be responsible for the implementation and facilitation of ongoing compliance auditing, monitoring, and education activities as indicated by the SSM HC CRP. This position will provide oversight and have primary responsibility for ensuring that SSM HC assigned entities have a robust CR program and remain in compliance with all federal healthcare program rules, regulations, and administrative requirements.
1. Imparts the philosophy, values, mission and vision of SSM Health Care and facilitates the integration of values in CQI activities.
2. Understands, embraces and practices the principles of CQI in utilizing the Malcolm Baldrige criteria as a means to achieve performance excellence.
3. Understands, embraces and models the SSMHC exceptional service standards.
4. Provides a personal example of living the principles of continuous quality improvement whereby decision making is driven by data, and customer relationships are facilitated both within and outside the system.
5. Conducts and evaluates risk assessments for assigned entities, determines the potential effect on the system and helps to develop recommendations regarding system response.
6. Responsible for the oversight and implementation the Corporate Responsibility Process (CRP) for assigned entity (or entities).
7. Prepares and delivers reports and updates to senior leaders, including annual reports to the board.
8. Serves as a resource to all departments of assigned entities in establishing methods to improve regulatory and legal compliance and reduce vulnerability to fraud, abuse, and waste.
9. In collaboration with Regional Director-Corporate Responsibility, periodically revises the entity policies and processes in light of changes in system policies, and in laws and regulations regarding government and private payer plans.
10. Evaluates the adequacy and effectiveness of internal controls designed to ensure that processes lead to appropriate execution of regulatory requirements and guidelines.
11. In collaboration with Regional Director-Corporate Responsibility, develop and implement CRP and HIPAA training program for employees, physicians, independent contractors and agents.
12. In collaboration with Regional Director-Corporate Responsibility, implement and facilitate the ongoing compliance coding audits, monitoring work plan completion and education activities associated with the physician auditing program.
13. Participate and lead internal audits and reviews of existing and new programs within the facilities, physician offices and long term care facilities.
14. Participate and support the coordination or verification of internal CRP and/or HIPAA review and monitoring activities, including CRP self-assessment of entities assigned.
15. In collaboration with Regional Director-Corporate Responsibility and entity leadership, develop and facilitate the completion of hospital, physician office and long term care work plans annually.
16. Investigate or coordinate with Human Resources to investigate CRP and/or HIPAA related inquiries from employees, patients, third parties and the CRP Helpline after consultation with the Director-Corporate Responsibility, as appropriate. Ensure timely and appropriate response to all inquiries.
17. Actively monitor open CRP/HIPAA issues for the assigned entities and have primary responsibility in investigating issues and bringing them to closure, including developing corrective actions plans in collaboration with leadership.
18. Responds to requests for information and feedback to system CRP Team regarding needs, policies, tools, education, internal audits, etc.
19. In collaboration with the Director, participates in the development and implementation of an internal privacy audit program to ensure system-wide compliance to system privacy policies.
20. Coordinates internal reporting of suspected disclosures, performs investigation, conducts breach analysis, performs patient communication and confirms corrective action with relation to disclosures of PHI.
21. Collaborates with departments within SSMHC to coordinate responses to requests for access to protected health information and requests for restrictions on the release of protected health information.
22. In collaboration with the Director initiates, conducts and/or coordinates internal and external audits and monitoring activities as necessary in order to ensure compliance with state and federal laws and regulations.
23. Performs other related duties incidental to the work described herein and other special assignments by the System Vice President-Corporate Responsibility or the System Director-Corporate Responsibility.
1. Bachelor's degree in Health, Business or related field with 5-7 years of applicable experience.
2. Understanding the Mission and Values of SSM Health Care and the Franciscan Sisters of Mary.
3. Knowledge of healthcare related compliance and auditing techniques.
4. Proven analytical and problem solving skills.
5. Proven capability to quickly build positive relationships and influence management and providers within the organization. Effective verbal and written communication skills, with the ability to communicate effective with all levels of management.
6. Excellent presentation skills, demonstrated ability to present oneself and one's ideas with clarity, confidence and poise.
7. Strong time management skills for working on multiple projects. Ability to work on assignments of varying difficulty and complexity, while exercising independent judgment.
8. Experience mentoring and training staff.
1. Professional and/or Hospital Coding Certification
About SSM Health Dean Clinic-
Based in Madison, Wis., Dean Clinic consists of a network of more than 60 clinics in south-central Wisconsin. Our more than 500 physicians provide primary, specialty and tertiary care in the clinics as well as eye care through our Davis Duehr Dean locations. Dean Clinic also offers urgent care services and operates outpatient surgery centers. Dean Clinic joined SSM Health in 2013.