1 month ago
(6/5/2018 2:23 PM)
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.
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
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
Bachelor Degree in Business Administration or a healthcare related field required, Master’s degree preferred. Certification in Healthcare Compliance required.
5 years healthcare regulatory or compliance related experience, including 3 years at a management level.
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.