Director of Compliance

Watertown, MA, United States

Ophthalmic Consultants of Boston (OCB) is currently seeking a Director of Compliance. This role will report to the Vice President of Operations and have a working relationship with the OCB Co-Presidents/Medical Director and the MD Compliance Committee. The Director of Compliance is responsible for the oversight of the OCB Compliance program as well as providing leadership and expertise with sensitivity and responsiveness to the needs of Ophthalmologists, Optometrists, and their patients and staff members.

The Director of Compliance is responsible for discovery, auditing, evaluating and recommending course of action related to compliance including coding, HIPAA, and AAAHC Credentialing for OCB and its Affiliates. The position ensures the Board of Directors, management and employees are following the rules and regulations of regulatory agencies, that company policies and procedures are being followed, and that behavior in the organization meets OCB and its Affiliate's standards of conduct.

The Director of Compliance handles designing, developing, implementing, supervising, and reviewing internal policies, procedures, processes and practices to assure all patient coding and documentation is accurately interpreted, captured and managed in accordance with regulatory and Practice requirements. Works across the practice and entities with providers, clinical managers, technicians, scribes, and billing personnel to educate, train, audit, research, investigate, problem solve and resolve compliance related requirements and issues; mitigating risks and reinforcing required practices to assure best practices are implemented and kept throughout the Practice and its affiliates.

Responsibilities include:

Develops, initiates, maintains and revises policies and procedures for the OCB Compliance Program and its related activities to prevent illegal, unethical, or improper conduct. Manages the day-to-day operation of the Program.

Maintains an in-depth and ongoing understanding of industry related compliance requirements, issues, coding updates, regulatory changes and industry related best practices.

Provides oversight of OCB's Compliance Program to ensure it is aligned with regulatory and Practice requirements by developing, implementing, monitoring and maintaining policies, procedures and programs to support ongoing activities and requirements of compliance program.

Coordinates and delivers educational training programs consisting of appropriate documentation guidelines, and accurate coding to all appropriate personnel including coding staff, scribes, clinical managers and technicians, physicians/providers, and billing personnel.

Maintains an in-depth and ongoing understanding of industry related compliance requirements, issues, coding updates, regulatory changes and industry related best practices.

Assures OCB's Compliance Program is aligned with regulatory and Practice requirements by developing, implementing, monitoring and maintaining policies, procedures and programs to support ongoing activities and requirements of compliance program.

Coordinates and delivers educational training programs consisting of appropriate documentation guidelines, and correct coding to all appropriate personnel including coding staff, scribes, clinical managers and technicians, physicians/providers, and billing personnel.

Performs internal audits and compliance reviews, identifying, escalating, resolving and managing requirements and issues in a timely and proactive manner.

Conduct regular coding audits and coordinate the monitoring of coding and documentation accuracy, reviewing claim denials and rejections pertaining to coding and medical necessity issues.

Develops and periodically reviews and updates MD's standards of conduct to ensure continuing currency and relevance in providing guidance to the MD staff.

Proactively identifies less-apparent coding issues and red flags, by monitoring data, reporting, and procedures/practices to anticipate the obvious and most complex of coding issues; continuously mitigating risks by escalating as needed and recommending remedies.

Collects, analyzes, interprets and documents information to support audit findings, present to all levels of management and providers regarding findings and recommendations.

Receives, investigates and reports on compliance complaints, subpoenas and summons and "hotline" reports.

Evaluates adequacy of managements and providers response to recommendations cited, provide feedback and reporting as needed and required.

Conducts annual audits as they relate to regulatory agencies assuring adherence to regulatory requirements.

Reports non-compliance issues detected through auditing and monitoring, create corrective action plans and results of follow-up audits to the Advisory Committee, MD Compliance, Chief Operating Officer and Senior Management.

Collaborates with other departments to direct compliance issues to proper existing channels for audit, investigation and resolution.

Responds to alleged violations of rules, regulations, policies, procedures, and standards of conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations. Maintains records including a variance log of reported incidents.

Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, and resolved.

Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to find trends. Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations in the future.

Provides reports on a regular basis, and as directed, to keep the Board and senior management informed of the operation and progress of compliance and risk management efforts.

Works with Human Resources and senior management to develop an effective compliance training program, including appropriate introductory training for new staff members as well as ongoing training for all staff members and clinicians to reduce risk exposure.

Serves as patient advocate, addressing and managing escalated patient concerns, serves on the OCB Management Team.

Education, Experience and Skills: Minimum of 10+ years of experience managing compliance, risk and/or regulatory programs in a health care setting, progressive experience in out-patient coding and billing preferred.

Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must.

Previous physician billing/auditing experience required.

Previous clinical experience in ophthalmology preferred.

Extensive knowledge of CPT coding principles, guidelines and practices is required.

Experience with performing physician compliance reviews of healthcare institutions especially subspecialties, ideally in an ophthalmic setting.

Strong knowledge base in complete and accurate clinical documentation

Knowledge of electronic medical records and practice management software

Strong knowledge of Federal (HIPPA) and State health care regulations, standards, policies and requirements pertaining to documentation, coding and billing.

The ability to accurately interpret and implement regulatory standards and legal requirements

Strong analytical and problem-solving skills; proficient in report writing and oral communications

Ability to influence, and hold accountable in a professional and diplomatic manner.

Proven leadership skills and proved ability to communicate effectively with all levels of management and personnel.

Highly organized with ability to multi-task and prioritize

Ability to establish and maintain effective working relationships with patients and staff members.

Bachelor's degree, or equivalent experience. Masters preferred.

Ability to travel to various offices

Benefits Offered: Health & Dental Insurance- starts 1st Day of Employment

Paid time off and Paid Holidays

Health & Dependent Reimbursement Accounts

401(k) Plan with Company Contribution

Co. paid Life and LTD Insurance

Employee Discounts

To find out more about OCB, please visit our website at www.eyeboston.com. OCB is an Equal Opportunity Employer

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