To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
The Compliance Specialist develops and performs various risk assessment and audit activities to assure compliance with federal and state laws, regulations, and priorities of the Office of Privacy and Corporate Compliance. The Compliance Specialist assists the System Compliance Officers in developing, implementing, and maintaining an effective and comprehensive corporate compliance and privacy program for the Delivery Networks, consistent with regulatory, contractual, and ethical requirements; Yale New Haven Health System policies; and industry practices.
- • 1. Assists System Compliance Officer in the development of an annual Work Plan and reporting performance indicators to measure the effectiveness of the compliance program at YNHHS.
• 2. Assists in the planning and implementation of conflict of interest education and training programs for all personnel. Assists the System Compliance Officer in the preparation of training materials and leads training sessions at the various Delivery Network sites.
• 3. Conducts investigations related to conflict of interest concerns. Recommends appropriate response and follow up keeping the System Compliance Officer updated as necessary. Institutes appropriate follow-up actions. Utilizes results of incidents to develop monitoring programs and Management plans.
• 4. Review, update, and develop compliance and conflict of interest policies and procedures to prepare for the policy approval process. Develop monitoring activities to assess compliance with policies.
• 5. Assists System Compliance Officer with responses to internal and external inquiries regarding conflicts of interest and requests for information.
• 6. Distributes, collects and reviews submissions in COI SMART, YNHHS’ online conflict of interest reporting system.
• 7. Ensures continuous on-boarding in COI SMART of Covered Individuals per policy.
• 8. Participates in committees and task forces, representing the Office of Privacy and Corporate Compliance.
• 9. Maintain current awareness of compliance laws and industry developments pertaining to compliance and privacy. Distributes information that reflects the work of the OPCC and that are useful for the employees, physicians and vendors throughout the delivery networks of the YNHHS system.
• 10. Handles all corporate compliance and conflicts of interest matters with sensitivity and maintains strict confidentiality of all work material and activities.
• 11. Under the direction of the System Compliance Officer, reviews Covered Individual conflict of interest disclosures for potential conflicts of interest and make an initial determination (based on a review of relevant policy/regulation) as to whether a potential conflict exists.
• 12. Reviews and reconciles YNHHS’ CMS Open Payments data reported annually to CMS.
• 13. Under the direction of the System Compliance Officer prepares reports, related analyses, and makes recommendations to assist management in ensuring compliance and improving internal controls.
• 14. Participates in the development of the OPCC Annual Work Plan by completing assigned work and work plan items and conducting at least one quarterly audit related to conflict of interest and/or compliance.
• 15. Works closely with staff to maintain open communications with the compliance and privacy program. Interfaces directly with Delivery Network employees and serves as a resource for addressing concerns about compliance, conflicts of interest and ethical questions.
Bachelor's degree in business, health care, or a related field. Master's degree preferred. Certification in healthcare compliance, auditing or related field desired. Ten years of work experience combined with active pursuit of a bachelor's degree will meet this requirement.
Minimum of five years experience in billing compliance, general compliance, privacy, health information management, finance, healthcare administration, or a related field.
CHC, CHPC and/or CPC preferred,
General knowledge of healthcare compliance issues. General knowledge of governmental regulations, including documentation and third party billing requirements and regulations. General knowledge of ICD-9 and CPT-4 coding. Attention to detail, effective report writing and presentation skills a must. Skilled at using Microsoft Word, Excel and PowerPoint. Aptitude for and interest in learning additional software and database programs. Project management skills. Experience interacting with physicians, department heads, and senior staff members of a hospital or health system. Experience communicating with regulatory and outside agencies is desirable. Team player and self-starter, capable of taking projects from conception to implementation. High level of integrity and trust.