Senior Compliance Officer, YM Compliance
Bargaining Unit: None - Not included in the union (Yale Union Group)
Time Type: Full time
Duration Type: Regular
Compensation Grade: Administration & Operations
Compensation Grade Profile: Senior Leader (M8)
Work Location: Medical School Campus
Worksite Address: 300 George Street, New Haven, CT 06511
Work Week: Standard (M-F equal number of hours per day)
Searchable Job Family: Administration, Clinical
Total # of hours to be worked:37.5
The Sr. Director, Yale Medicine Compliance establishes and implements an effective compliance program for Yale Medicine. This position promotes the highest standards of ethical behavior and conduct, and provides expertise, consultation, and assessment related to compliance matters managed by Yale Medicine (YM). The Sr. Director, Yale Medicine Compliance collaborates with the Institutional Compliance Program Manager (ICPM) for Yale University to coordinate initiatives which identify, prevent, and appropriately mitigate compliance risk, and ensure that YM compliance efforts align with the university’s broader compliance strategy and framework. The Sr. Director, Yale Medicine Compliance promotes a compliant culture appropriate for a large physician organization with clinical affiliations across multiple academic and non-academic medical centers. The Sr. Director, Yale Medicine Compliance reports directly to both the YM CEO and the Chair of the YM Board of Directors.
This position provides strategic direction and oversight regarding all compliance matters managed by YM, including medical billing compliance, clinical conflict of interest, and provider credentialing. This position also closely collaborates with other individuals and units at the university that have compliance responsibilities which intersect with YM, including the ICPM, Enterprise Risk Management, University Auditing, HIPAA Privacy, IT Security, Yale Center for Clinical Investigation, and Environmental Health and Safety. The Sr. Director, Yale Medicine Compliance serves as a role model for ethical and moral principles that are consistent with the mission, vision, and values of YM and with the practices required by federal and state law. The Sr. Director, Yale Medicine Compliance is responsible for directing the compliance activities engaged in by YM and setting the strategic direction of the work plans and deliverables of the YM compliance offices, such as the Medical Billing Compliance Office and Credentialing Office. At the direction of the YM Board and in consultation with the Office of General Counsel, the Sr. Director, Yale Medicine Compliance is authorized to respond to federal, state, and commercial entities with regards to YM compliance matters.
- Reports directly to the YM CEO and the Chair of the YM Board of Directors; participates in regularly scheduled meetings and communicates the status of compliance efforts; and is authorized to report on matters related to the YM compliance program to the full YM Board at any time. Serves as a key member of the YM senior leadership team.
- Work closely with YM leadership to understand the overall strategy of YM. Develop a close working relationship with Chairs of the Yale School of Medicine Clinical Departments and effectively interface with leadership when corrective actions are needed. Develop the strategy for the YM Compliance Program and supervise the staff of the YM Compliance Departments. Provide consolidated reporting of work plan activities for all YM compliance department to ensure the YM Board has full transparency into compliance activities and results.
- Collaborate with the ICPM and other units at the university with compliance responsibilities which intersect with YM and maintain strong relationships and open communication with the staff in those units to ensure close coordination of efforts. Understand the connections between YM-owned compliance matters and compliance matters that are the responsibility of other areas of the university. Facilitate and coordinate compliance activities with other units as necessary and appropriate, including the development and implementation of a process to coordinate compliance due diligence for clinical practice acquisitions. Collaborate with compliance personnel at applicable affiliate organizations as necessary and appropriate.
- Develop, maintain, and revise compliance-related policies and procedures for the operation of YM and applicable affiliates and their related activities to prevent (re)occurrence of illegal, unethical, or improper conduct. Establish and oversee a record-keeping system designed to document the ongoing operation of the YM compliance program.
- Institute and maintain effective compliance communication practices for YM and its affiliates, employees, physicians, residents, clinical staff, coders, billing personnel, and other affected individuals through training, newsletters, memos, etc. Establish regular training and a process to document both the content of and attendance at compliance training sessions.
- At the direction of Counsel, cooperate with outside oversight and regulatory agencies (including but not limited to the U.S. Department of Health and Human Services and its component offices, such as the Office of the Inspector General and the Office of Civil Rights) during compliance reviews or investigations. At the direction of Counsel, conduct or oversee investigations into alleged violations of law, regulation, or policy related to YM operations; work with appropriate parties to handle violations promptly, properly, and consistently.
- Oversee compliance reviews for YM management to assess effectiveness of programs and internal controls designed to ensure compliance with regulatory requirements applicable to YM operations. Provide management with reports of completed assessments for their review and response.
- Hire, train, develop, and performance manage the YM corporate compliance team. Lead and support the compliance team in developing and improving compliance operations to create optimal performance levels.
- Plan, monitor and manage the budget for the Yale Medicine’s entire compliance program.
- Perform other duties as required.
Required Education and Experience
Bachelor’s Degree and ten years of related work experience and currently holds a leadership position in Compliance. Previous experience in a leadership capacity in Compliance required.
Required Skill/Ability 1:
In depth Knowledge and experience of relevant laws and regulations (e.g., coding, billing, Medicare and Medicaid reimbursement, fraud and abuse laws, Medicare Conditions of Participation, the Stark and Anti-kickback statutes, HIPAA, FDA, DPH, and HHS-OCR) and enforcement.
Required Skill/Ability 2:
Proven history of successful results in managing issues and driving strategic program initiatives. Demonstrated strong negotiation, influencing, and relationship management skills.
Required Skill/Ability 3:
Excellent verbal and written communication skills required along with demonstrated facilitation, communication, and executive presentation skills.
Required Skill/Ability 4:
Demonstrated ability and competency with computer systems required, including web-based applications and some Microsoft Office applications.
Required Skill/Ability 5:
Excellent execution, follow up, project management and coordination skills. Strong analytical skills.
Preferred Education, Experience and Skills:
Advanced Degree in Healthcare, Law or Accounting strongly preferred. Certificate in Healthcare Compliance.
Preferred Licenses or Certifications:
One or more certifications as a professional Coder and/or Certified Coding Specialist.
Background Check Requirements
All candidates for employment will be subject to pre-employment background screening for this position, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position description and job requirements. All offers are contingent upon the successful completion of the background check. Please visit www.yale.edu/hronline/careers/screening/faqs.html for additional information on the background check requirements and process.
The intent of this job description is to provide a representative summary of the essential functions that will be required of the position and should not be construed as a declaration of specific duties and responsibilities of the particular position. Employees will be assigned specific job-related duties through their hiring departments.
Affirmative Action Statement:
Yale University considers applicants for employment without regard to, and does not discriminate on the basis of, an individual’s sex, race, color, religion, age, disability, status as a veteran, or national or ethnic origin; nor does Yale discriminate on the basis of sexual orientation or gender identity or expression. Title IX of the Education Amendments of 1972 protects people from sex discrimination in educational programs and activities at institutions that receive federal financial assistance. Questions regarding Title IX may be referred to the University’s Title IX Coordinator, at TitleIX@yale.edu, or to the U.S. Department of Education, Office for Civil Rights, 8th Floor, Five Post Office Square, Boston MA 02109-3921. Telephone: 617.289.0111, Fax: 617.289.0150, TDD: 800.877.8339, or Email: email@example.com.
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