Compliance Program Manager Jobs in Ohio

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Job Description Summary:

The primary focus of this role is to lead the contracting strategy, by developing, implementing, communicating, managing and monitoring the needs of the physician contracting program. This role is a subject matter expert, with current knowledge of policies, procedures, compliance, fair market value acumen and state & federal rules and regulations. The depth of specialized expertise within the role is necessary and must be maintained to facilitate the success of the compliance initiatives aligned with physician contracting. The purpose of this position is to: (a) lead and manage the physician contracting program by ensuring all individual physician and physician group contracts are in full compliance with hospital policies and governmental regulations, (b) manage the physician payroll process to ensure timely and accurate payment for services, and to (c) oversee monitoring of the monthly department and financial reports to maintain expenditure controls. In addition, this position contributes to the development of contracting strategy projects and captures and tracks program trends.

In this position, you will work cross-functionally with leadership, legal and key stakeholders on matters related to physician compensation in assigned hospitals to help meet business objectives while ensuring compliance with all federal, state and local laws and regulations.

Responsibilities And Duties:

• 30%: Budget development and complex financial reporting. Manage payment administration, monthly variance reporting and reconciliation process for hospital contracted or employment services physician or physicians groups for payment through accounts payable or payroll i.e., administrative, medical directorships, advisory, call coverage and/or clinical services, etc. which consists of daily responsibilities. Provide timely, accurate and appropriate levels of information to facilitate sound decision making. Clearly and professionally communicate contract terms and payment structures to physicians, hospital leaders and other key stakeholders. Assist in analysis and coordination of amendments, reimbursement, and contractual language changes. Interacts closely with executive team and system stakeholders addressing strategic goals and objectives.

• 20%: Develop and produce custom and system templates, forms, guidelines, procedures, executive and associate user guides, audit materials/checklists, etc. for cross-campus physician contract compliance use. This includes development and maintenance of an extensive physician contract manual for executive use only.

• 15%: Ensure all physician contracts are documented, processed, implemented and paid within appropriate fair market value by OhioHealth system policies, standards, and abiding by state and federal laws.

• 20%: Create, implement and manage a relational database for each physician contract relationship with hospital with advanced tracking and customize report capabilities.

• 10%: May design, maintain, and administer campus-specific or system-wide projects related to physician contract policy/process. Provides consultative services as content expert to other caresites regarding physician contracting policy/process.

• 5%: Participating member or invited as the Content Expert of the following; Physician Economic Advisory Committee, OhioHealth Physician Contract Work Groups, OhioHealth Ethics & Compliance Steering Committee, Physician Contract Audit Teams and Riverside Executive Team.

• 5%: Meet with government regulators or surveyors during announced or unannounced site visits and audits i.e., Office of the Inspector General, The Joint Commission, Center for Medicare & Medicaid Services, Internal Revenue Service, etc. This position will serve as the primary campus contact for regulatory visits. This position is responsible for implementing any necessary corrective action plans. The major duties, responsibilities and listed above are not intended to be all-inclusive of the duties, responsibilities and to be performed by employees in this job. Employee is expected to all perform other duties as requested by supervisor.

As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.

The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time.

Minimum Qualifications:

Bachelor's Degree: Healthcare (Required)
CHC - Certified in HealthCare Compliance - HCCA Health Care Compliance Association

Additional Job Description:

• Field of Study: Business
• Field of Study: Healthcare
• Field of Study: related field.

Years of experience: 5

SPECIALIZED KNOWLEDGE

• Field of Study: business or healthcare related field.
• Extensive Experience in the highly specialized field of physician contracts may be considered as substitution in lieu of degree.
• Physician fair market value analysis Experience.
• Financial reporting skills.
• Demonstrated knowledge/understanding of Hospital/service line operations and concepts; Medical staff organizational structure; legal and healthcare terminology.
• Ability to independently identify solutions to complex problems and process faults.
• Ability to multi-task and prioritize requests from multiple senior executives simultaneously.
• Excellent writing composition skills; strong communication skills with ability to address and interact with high level executives and physicians in a professional manner.
• Strong organizational skills.
• Advanced computer MS application expertise.
• 5 years of hospital physician contracting Experience, database management Experience (Access, Excel and/or SharePoint).

DESIRED ATTRIBUTES

• 5+ years of hospital physician contracting experience, database management expertise (Access, Excel and or SharePoint), complex financial reporting capabilities and effective presentation and verbal skills desired.
• 10 years experience with a hospital or healthcare organization.

Work Shift:

Day

Scheduled Weekly Hours:

40

Department:

Medical Affairs

Join us!

... if your passion is to work in a caring environment

... if you believe that learning is a life-long process

... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment.