Education:
Bachelor’s degree in nursing required Advance degree and/or certification (e.g., MBA, MSN, or JD): multiple educational backgrounds are appropriate, such as health, legal, clinical, etc preferred.
Experience:
7-10 yrs of experience in hospice and palliative care. with related healthcare compliance experience
Skills
§ Knowledge of business and management controls; general review and audit processes.
§ Knowledge of Medicare billing and third-party payer coding and billing regulations.
§ Skill in oral and written communication
§ Skill in using computers and personal productivity applications
§ Skill in financial and data analysis
§ Skill in public speaking and presenting to groups
· Ability to identify routine and complex audit-related problems.
· Experience managing multiple office locations.
§ Strong leadership and communication skills
§ Advanced knowledge in leading organization-wide initiatives
§ Ability to understand and articulate complex regulatory information
Licensures Certifications
· Complete Hospice Regulatory Bootcamp within one year
· PI Master within one year
Physical Requirements
· Ability to sit, stand, walk, concentrate, and pay close attention to detail
Working Conditions
· Works in normal office environment where there are no physical discomforts due to dust, dirt, noise, and the like. Regular travel between office and main hospital campus.
Patient & Workplace Safety
Employee has knowledge and understanding of patient and workforce safety as it relates to job duties.Patient Population
Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable.
Principle Duties and Responsibilities
Manages the entire Compliance Program for Gilchrist , which falls under
the Compliance Program for the GBMC health system.
Monitors audit related resources and websites (if applicable) to ensure that
up-to-date audit mitigation strategies are in place for Gilchrist
Develops and maintains policies and procedures for compliance-related activities to ensure consistency and compliance among the various staff and teams. Primary focus is on initial and ongoing eligibility for services with clear supportive documentation. Assists with , coding, billing and reimbursement areas as needed
Monitors responses to inquiries regarding audits s including the full
process of appeals and reports findings and trends for service line and
senior leaders.
Recommends development of new policies and procedures, as a result of
pre-billing reviews, audit findings, documentation and subsequent
investigations.
Develops and implements educational programs for the Gilchrist divisions
and service areas as needed to respond to regulatory initiatives and
identified deficiencies.
Prepares and submits reports on the results of pre-bill and audit findings ,
recommending improvements in policies and procedures, staff
development and educations and modifications to mistake proof the EMR.
Develops and communicates corrective action plans, following up as
needed with leaders
With guidance from GBMC’s Compliance Officer, supports the leaders
with the investigation of any issues of non-compliance and implements
appropriate corrective regulatory procedures in a thorough and accurate
manner.
Develops quarterly written reports on Compliance activities to GBMC’s
Audit and Compliance Committee of the Board.
Maintain working knowledge of CMS conditions of participation and Medicare
billing requirement. Participates in all NPHI regulatory sessions with President.
Reviews the annual OIG, MedPac reports and PEPPER reports which along with
pre-billing and audit findings is used to create an annual compliance plan, which
is incorporated into the GBMC health system’s annual compliance plan. The
annual plan is subject to approval by GBMC’s Audit and Compliance
Committee of the Board and the plan’s progress is reported to the Gilchrist
Governance Committee monthly.
Ensures information retained and disseminated is handled in accordance
with Gilchrist policies as well as according to standards established by
outside agencies (ex: CHAP,CMS, Medicaid, & HIPAA).
Attends GBMC’s Compliance and Risk Management Committee. Receives reports of suspected HIPAA violations from Gilchrist staff, physicians, or patients and elevates to GBMC’s Compliance Officer
All roles must demonstrate GBMC Values:
Respect
I will treat everyone with courtesy. I will foster a healing environment.
Treats others with fairness, kindness, and respect for personal dignity and privacy
Listens and responds appropriately to others’ needs, feelings, and capabilities
Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
Meets and/or exceeds customer expectations
Actively pursues learning and self-development
Pays attention to detail; follows through
Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
Sets a positive, professional example for others
Takes ownership of problems and does what is needed to solve them
Appropriately plans and utilizes required resources for various job duties
Reports to work regularly and on time
Teamwork
I will be engaged and collaborative. I will keep people informed.
Works cooperatively and collaboratively with others for the success of the team
Addresses and resolves conflict in a positive way
Seeks out the ideas of others to reach the best solutions
Acknowledges and celebrates the contribution of others
Ethical Behavior
I will always act with honesty and integrity. I will protect the patient.
Demonstrates honesty, integrity and good judgment
Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers
Results
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
Embraces change and improvement in the work environment
Continuously seeks to improve the quality of products/services
Displays flexibility in dealing with new situations or obstacles
Achieves results on time by focusing on priorities and manages time efficiently
Pay Range
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
COVID-19 Vaccination
All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.