Job Abstract

This position assists the Sutter Health Plan Ethics & Compliance Officer and ethics & compliance leadership in the oversight and administration of the ethics & compliance program at the entity level to ensure compliance with the organization’s policies and procedures and applicable state and federal laws, regulations, and standards (e.g., General Compliance Program Guidance, antifraud laws, physician self-referral laws, and anti-kickback statutes). This role requires in-depth knowledge of requir... more details

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview:

This position assists the Sutter Health Plan Ethics & Compliance Officer and ethics & compliance leadership in the oversight and administration of the ethics & compliance program at the entity level to ensure compliance with the organization’s policies and procedures and applicable state and federal laws, regulations, and standards (e.g., General Compliance Program Guidance, antifraud laws, physician self-referral laws, and anti-kickback statutes). This role requires in-depth knowledge of requirements for managed health care plans and value-based care including, but not limited to, the California Knox-Keene Act and Centers for Medicare & Medicaid Services (CMS) alternative payment models.

Works with and serves in the absence of ethics & compliance officers in overseeing, coordinating, implementing, administering, and evaluating the Sutter Health ethics & compliance program at assigned entity within a market/network/service line(s). May serve as a member of entity senior leadership team. Collaborates with entity senior leadership and organizational staff throughout the market/network/service line(s), ethics & compliance staff, and Legal & Risk Services team members regarding changes in federal and state laws and regulations and the organization's policies and procedures. Monitors laws and regulations that apply to designated entity operations and leads response efforts for select state and federal government inquiries, regulatory filings, and audits.

Plans, executes, and leads a variety of regulatory compliance-based projects. Leads in the day-to-day management of ethics & compliance incident response process. Conducts investigations at levels of risk and reports on compliance risk assessments and assists with the development of compliance policies and procedures. Serves as a resource person to perform the various activities of the ethics & compliance program and includes monitoring, investigation coordination, data quality assurance, training, and education, and managing any confidential reporting received via mailbox or phone messaging. This position will perform trending, analysis and metric reporting related to ethics & compliance incidents and make recommendations for control implementation, education opportunities and remediation.

Job Description:

The person hired for this role must live in the Nothern California Sutter Health footprint and come on site for meetings, work, etc.

This role will cover SHP (Sutter Health Plan), SMD (Sutter Medicare Direct), and SHSO (Sutter Health System Office).

Travel across the system may be required as needed for this role.

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma

Bachelor’s in Business Administration or related field

CERTIFICATION & LICENSURE:

CHC -Certified in Healthcare Compliance

TYPICAL EXPERIENCE:    

8 years recent relevant experience

SKILLS AND KNOWLEDGE:

In-depth knowledge of effective healthcare ethics and compliance program, including requirements, management, monitoring, conducting, and documenting investigations, addressing violations, tracking corrective actions, and training.

In-depth knowledge of healthcare clinical operations, hospital revenue cycle systems, and healthcare billing and coding requirements.

Working knowledge of medical terminology, standard medical abbreviations, and the disease process as well as general legal terminology, principles, procedures, and available legal resources.

Familiar with healthcare industry, including current trends, cultural concerns, and local/state/federal regulations, such as the CA Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act (ACA), and HIPAA regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Income Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws.

Exceptional attention to detail with excellent time management and organization skills, including the demonstrated ability to strictly adhere to multiple timelines.

Strong business acumen and exceptional analytic skills with the proven ability to analyze data and information, reach practical conclusions, recommend corrective actions, resolve conflicts, and institute effective changes.

Excellent written/verbal communication, interpersonal, and presentation skills with the ability to translate complex legal and regulatory requirements, healthcare laws, or sensitive information clearly and diplomatically to diverse audiences.

Proficient computer skills, including advance competency in Microsoft Office Suite (Word, Excel, Visio, Project, and PowerPoint), and other software.

Ability to manage and organize large amounts of data in an efficient and clear manner, specifically in a regulatory and compliance-filing function.

Identify potential concerns and compliance issues, and then assist in the development and implementation of actionable recommendations or process improvements to resolve the problem.

Advise management and other stakeholders regarding the impact of emerging industry trends in compliance enforcement, legislation, and regulations.

Abstract information from medical records, reports, chart entries, related patient documentation, and interviews while conducting audits and investigations.

Work independently, as well as part of a multidisciplinary team, while efficiently and effectively conducting audits and investigations within established timeframes and government regulations.

Direct, prioritize, and drive multiple projects while navigating competing priorities to deliver quality products and services on-time and on-budget.

Make informed decisions based on the analysis of multiple sources of information while providing new perspectives on existing solutions.

Foster an open and collaborative environment that invites discussion about the compliance process and its value, influences individuals or groups with diverse opinions, builds consensus, and enlists cooperation without direct control/authority.

Maintain strict confidentiality of sensitive material (compliance and risk management data) and ensure the privacy of each patient’s protected health information (PHI).

Work effectively with staff, peers, senior management, physicians, state/federal agencies, and external organizations.

Build collaborative working relationships with peers, other departments, stakeholders, management, vendors, and government agencies to achieve compliancy.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Monday - Friday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.

Pay Range is $62.95 to $94.43 / hour

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Qualified applicants with arrest and conviction records will be considered for employment. Applicants for specific positions are still required to disclose certain convictions during the application process, and those convictions may also be considered in determining eligibility for employment in accordance with applicable law.

Apply Apply Later