Clinical Pathology

  • Compliance Director

    Job Location US-TX-Austin
    Posted Date 2 weeks ago(6/5/2018 2:23 PM)
    Type
    Regular Full-Time
    Shift
    First shift
  • Overview

    Position Summary:  The Compliance Officer manages the Compliance Program and Compliance Department for Clinical Pathology Laboratories.   Reviews, revises and maintains compliance policies to keep them current with regulations and CPL procedures.   Is an active participant in defining other CPL policies and procedures to ensure compliance with applicable regulations.  Is an active participant in compliance education for all employees.

     

    #CB 

    Responsibilities

    Principal Responsibilities:

    • Direct responsibility to meet the required elements of a Compliance Program set by the OIG:
      • Development and distribution of written standards of conduct, policies and procedures.
      • Annual Compliance plan review
      • Evaluation of Compliance plan effectiveness
      • Monitoring annual Compliance training
      • Annual review and updates as necessary Compliance policies and procedures
      • Hotline maintenance and education
      • Guidance for disciplinary action for employees that violate or fail to comply with Compliance policies and procedures
      • Auditing and monitoring – minimum audits should include kickback arrangements, the physician self-referral prohibition, CPT coding and billing, ICD coding, claim development and submission, reimbursement, marketing, reporting and record keeping.
      • Responding to detected offenses and developing corrective action initiatives
    • Oversight of Administrative Compliance to include:
      • Clinical trial research
      • NCD-LCD
      • Federal requests for records
      • Requisition design and review
      • Maintenance of exclusion database
      • Medicare/Medicaid applications and renewals
      • Test review to include CPT codes, PI review, Unit code review
      • Custom profile review
    • Manage Compliance Department
      • Schedule duties for compliance specialists
      • Perform annual Risk Assessment to define audits needed
      • Ensure audits are performed timely and reported in appropriate format
      • Review and interpret audits, help to define corrective action needed
      • Assign monitors to department managers and audit results
      • Periodically audit elements of the Compliance Plan
      • Hold periodic Compliance Committee meetings to present results of audits
    • Develop and maintain compliance resources
      • Revise or create annual compliance training modules
      • Participate in compliance education at manager meetings, phlebotomy meetings, new sales training, QI/Ops calls, etc.
      • Communicate and promote the Compliance Plan and Standard of Conduct to employees in a useful and understandable format
      • Revise and maintain forms and procedures to prevent violation of policy
      • Remain current with all applicable laws, rules and regulations
      • Review and approve standard operating procedures and management controls when relevant to compliance
      • Be a resource for all CPL SW Division personnel concerning possible compliance issues
    • Regular visits to Regional locations
    • Investigate all compliance concerns/complaints
    • Oversight of HIPAA

    Qualifications

    Education:  Bachelor Degree in Business Administration or a healthcare related field required, Master’s degree preferred.  Certification in Healthcare Compliance required.

     

    Experience:  5 years healthcare regulatory or compliance related experience, including 3 years at a management level.

     

    Skills:   A good working knowledge of healthcare compliance, Stark, Anti-kickback statutes.  Strong knowledge of Medicare and Medicaid billing requirements preferred. 

    Ability to interpret rules and regulations affecting laboratories and/or locate sources to assure correct interpretation of these rules and regulations.  Ability to remain current regarding rules and regulations as they may be revised by various sources such as the Centers for Medicare and Medicaid Services, the DHHS Office of Inspector General, and state regulators such as the Department of State Health Services, the State Board of Medical Examiners, the State Department of Insurance, , and local carriers in each state.

    Ability to communicate with CPL staff and customers effectively to convey information to promote compliance with rules and regulations applying to laboratory operations

    Ability to establish and refine, as needed, systems to effectively monitor CPL compliance with rules and regulations applying to laboratory operations.

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