VP, Billing, Monitoring and Risk Assessment - UPMC
Job Summary
The Vice President, Billing, Monitoring and Risk Assessment manages the billing and monitoring activities of the Corporate Compliance Department. This includes, but is not limited to, billing and coding compliance, annual and ongoing risk assessments, auditing and monitoring projects, education/training programs, billing research and guidance. This position will function as the authority on compliance and audit matters and will be responsible for reporting on compliance activities to the various executive oversight committees as well as Entity, Divisional, and Corporate Boards of Directors and their designated subcommittees. The Vice President will report directly to the Chief Compliance Officer UPMC.
Responsibilities
Professional Compliance and Audit Responsibilities
• Manages the billing and monitoring program(s) to ensure the elements of an effective compliance program are met or exceeded including the development and annual as well as regular review of compliance risk assessment auditing & monitoring activities.
• Assesses risks from a compliance and audit standpoint routinely, using sophisticated analytics and tracking and trending of information showing reliance on other lines of defense where appropriate to avoid duplication and create appropriate coverage for the Division(s).
• Chairs Compliance oversight meetings for the Division(s) as applicable to monitor compliance to Billing and Reimbursement regulations by third party payors, including Medicare and Medical Assistance.
• Manages and oversees the development and execution of an effective auditing and monitoring program for various compliance risks. This effort uses appropriate data analytics and sampling techniques to best assess the risk and create an appropriate corrective action plan for any deficiencies as well as a thorough follow-up process to ensure resolution.
• Assists in establishing, communicating, and enforcing policies and procedures for the Division(s).
• Maintains awareness of laws and regulations, keeping abreast of current changes and enforcements that may affect health care systems through personal initiative, seminars, newsletters, training programs, and peer contact.
• Acts as an independent review and evaluation body to ensure compliance issues/concerns, including Compliance Ask Us inquiries are appropriately evaluated, investigated, and resolved.
• Identifies areas of compliance vulnerability, develops, and implements corrective action plans, and consults with and coordinates through the other Corporate Compliance Office leaders to resolve complex issues.
• Coordinates and facilitates the work of compliance-dedicated staff for all high-risk compliance topics, including billing and coding, quality assurance, and reimbursement staff, as needed.
• Monitors and coordinates, directly or through the Revenue Cycle efforts, review and response of external third-party payer audits for the Division(s).
• Responsible for maintaining compliance awareness and communicating knowledge of changes to existing applicable federal and state regulations and subsequent implementation to ensure compliance.
• Ensures that education and training sessions related to specific compliance topics are planned, developed, and conducted throughout the Division(s).
• Develops, monitors, and responds to a full range of financial, service, and quality indicators in all areas of responsibility.
• Accountable for efficient and effective management of financial resources in the Compliance Department.
• Manages the Data analytics work for the compliance department, including by not limited to compliance systems, software and intracompany webpages.
• Willingness to travel locally and internationally, depending on scope of position.
Professional Privacy Responsibilities
• Responsible for ongoing monitoring of privacy policies and procedures; investigates and resolves allegations of Privacy violations and the Office of Civil Rights complaints directly or through designated entity Privacy Officers.
Leadership and Collaboration with the Corporate Office
• Acts as the liaison with UPMC system-wide compliance initiatives, including the annual conflict of interest process and investigation of alleged conflicts of interest.
• Compiles board level summary information and attends quarterly Ethics and Compliance Committee meetings to represent Division(s) compliance program.
• Recruits, trains, and develops staff as well as creates and maintains a leadership succession plan for the compliance related work for the Division(s).
*Performs in accordance with system-wide competencies/behaviors.
*Performs other duties as assigned.
*Performs in accordance with system-wide competencies/behaviors.
*Performs other duties as assigned.
Educational and Knowledge Requirements
• Bachelor's degree in business, law, nursing, healthcare administration or related field.
• Master's degree or compliance related certification required
• A minimum of 10 years of experience in compliance-related areas such as Regulatory Review, Reimbursement, Billing, Medical Records, Clinical Laboratory, or Physician Practice Management.
• A minimum of 5 years of previous experience in related leadership roles required.
• Healthcare experience on federal and state provider requirements is required
• Computer skills and well-developed analytical, problem-solving skills
Licenses and Certifications Notes
Juris Doctorate (JD), Certification in Healthcare Compliance (CHC), Master's Degree or other related regulatory, coding, or clinical Licensure/Certification required