Job Overview:
This position reports to TriHealth VP Chief Compliance, Privacy & Audit Officer (CCO) and plays an integral role in assisting the internal system and structure aimed at ensuring TriHealth's fulfillment of policy requirements as well as statutory and regulatory obligations relevant to Healthcare Compliance, to include HIPAA (“the Program”). The Advisor conducts investigations; auditing and monitoring; participates in annual risk assessments; and executes Work Plan and other ongoing Program initiatives. The Advisor maintains proactive and collaborative working relationships with various cross-functional teams, operational leaders, and committees to ensure Program objectives are achieved in a highly matrixed environment.
Job Requirements:
Bachelor's Degree ; Compliance, Business, Jurisprudence, Healthcare Administration, or other applicable curriculum
Equivalent experience accepted in lieu of degree
Health Care Compliance Association membership preferred
2-3 years experience Compliance, Legal/Regulation/Governance, Investigations, Coding, Auditing, Healthcare Administration or other applicable experience
2-3 years experience Professional
Gathers and maintains knowledge of compliance-related regulations within two (2) years of tenure in the role:
Documentation, Billing, & Coding Licensure Requirements Stark Antikickback Fraud, Waste & Abuse HIPAA/Privacy or False Claims Act Medical Necessity Requirements Disability & Anti-Discrimination
Job Responsibilities:
Conduct timely Compliance and Privacy investigations ("Compliance Matters/CM"), document findings, and regularly report those findings to the CCO and Program governance committees in accordance with department investigation protocols.
Formulate and deliver correct and timely guidance appropriate to the audience in order to support a wide range of Operations requirements from individual team members' questions to large scale development activities.
Deliver accurate and effective communication and education, spoken or in writing, consistent with Program requirements and the TriHealth Way of Serving to team members, external regulators, patients, and the general public.
Completes assigned Work Plan items and other Program initiatives like auditing and monitoring within scope and on time.
Assists in the development of Corrective Action Plans and resolution of CM ensuring completion by accountable parties, up to and including repayment and disclosure to government entities.
Assists in identifying potential organizational risks via the formal risk assessment process and other Program initiatives.
Participates in routine Program management activities: Compliance Matter and Inquiry triage, completion of committee agendas, minutes and presentations, provision of education, and policy & procedure maintenance.
Other Job-Related Information:
Strong written and spoken communication including active listening. Ability to write investigative summaries, audit results, Corrective Action Plans, and policies.
Strong critical analysis with creative and strategic thinking in order to gather facts and determine how those facts measure against policy and procedure.
Possesses sound judgment and decision-making in order to recommend correction that is appropriate both theoretically and practically.
Ability to respond to inquiries and design and complete investigation or projects with minimal supervision in a constantly evolving environment while maintaining a drive for results, such that work items are initiated, managed, and completed correctly and on time.
Collaborative team player with interpersonal skills, possessing the ability to earn co-workers trust as an informed advisor and solutions-orientated partner.
Ability to motivate and influence others in order to move toward a common vision or goal.
Strong professional ethics and commitment to TriHealth’s Mission and Vision.
Working Conditions:
Climbing - Rarely
Concentrating - Consistently
Continuous Learning - Frequently
Hearing: Conversation - Frequently
Hearing: Other Sounds - Consistently
Interpersonal Communication - Consistently
Kneeling - Rarely
Lifting <10 Lbs - Rarely
Lifting 50+ Lbs - Rarely
Lifting 11-50 Lbs - Rarely
Pulling - Rarely
Pushing - Rarely
Reaching - Rarely
Reading - Consistently
Sitting - Consistently
Standing - Rarely
Stooping - Rarely
Talking - Consistently
Thinking/Reasoning - Consistently
Use of Hands - Consistently
Color Vision - Occasionally
Visual Acuity: Far - Rarely
Visual Acuity: Near - Consistently
Walking - Rarely
TriHealth SERVE Standards and ALWAYS Behaviors
At TriHealth, we believe there is no responsibility more important than to SERVE our patients, our communities, and our fellow team members. To achieve our vision and mission, ALL TriHealth team members are expected to demonstrate and live the following:
Serve: ALWAYS…
• Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
• Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel: ALWAYS…
• Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
• Offer patients and guests priority when waiting (lines, elevators)
• Work on improving quality, safety, and service
Respect: ALWAYS…
• Respect cultural and spiritual differences and honor individual preferences.
• Respect everyone’s opinion and contribution, regardless of title/role.
• Speak positively about my team members and other departments in front of patients and guests.
Value: ALWAYS…
• Value the time of others by striving to be on time, prepared and actively participating.
• Pick up trash, ensuring the physical environment is clean and safe.
• Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Engage: ALWAYS…
• Acknowledge wins and frequently thank team members and others for contributions.
• Show courtesy and compassion with customers, team members and the community