Regional Compliance Consultant

Regional Compliance Consultant serves as the primary focal point for all compliance related affiliate consulting activities within one or more of the primary focus areas within compliance to include but not limited to auditing, monitoring, patient privacy, information security, billing, coding, research, policy and procedure development/oversight, and the overall compliance program for Billings Clinic Affiliates. Position is responsible for researching and remaining informed on related compliance regulations, laws and guidelines, implementing compliance plans, developing policies, training, and auditing. Position is responsible for audits, training, and orientation relative to assigned areas. Position is responsible for facilitating and/or participating in committees related to regional service compliance. The Regional Compliance Consultant works closely with the Compliance Officers, Privacy Officers, and Information Security Officers in the region to ensure compliance guidelines are adhered to and high-risk areas are identified and addressed. Responsible for quality of the service and all compliance related deliverables under the Managed Services Agreement. Essential Job Functions • GENERAL Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and the eight elements of the Compliance Program. • Policy Support Participates in the development, maintenance, communication, interpretation, education, and oversight of policies, procedures, and protocols in accordance with organizational Regional Leadership, Regional Compliance Affinity Group, and legal, and/or regulatory requirements. Provides clarity, advice, and guidance on policy compliance efforts. • Structure Serves as an advocate and resource for all levels of regional Affiliates. Works with leadership in assessing and addressing assigned compliance program concerns and assists with recommendations to address needs. Assists in identifying and resolving various operational issues. Provides assistance and support to the Regional Operations Team and Compliance Officer in a variety of capacities including but not limited to: Participates in developing, implementing, reviewing, and evaluating the Affiliate compliance programs. Participates in and supports initiatives to identify risks. Participates in and supports initiatives to address corrective action plans for identified compliance issues Participates in and /or facilitates compliance-related committees, project task teams, and/or improvement initiatives. • Lines of Communication Communicates to assigned areas about the established systems in place for soliciting information and employee concerns related to the compliance program, compliance concerns, and compliance-related questions. Participates in regular compliance consulting around reporting of key metrics to the Regional Service Leadership team and other diverse audiences and/or committee structures to assure they are generally informed of compliance issues and developments, and with the intent of improving the prevention and/or detection of any noncompliance. • Auditing & Monitoring Provide consulting support to Affiliate or managed sites in the development of annual audit planning. Monitors the effectiveness of the compliance programs at Affiliate or managed sites on a regular basis, ensuring adequate internal controls are in place to prevent and detect significant instances or patterns of illegal, unethical, or improper conduct. Provides consulting support to Affiliate partners related to enterprise risk management and development of annual compliance audit plans. Arrange and coordinate internal audits to monitor and detect non-compliance with applicable laws and compliance program requirements. Prepares reports documenting auditing findings, conclusions, suggested corrective actions, recommendations, areas of risk and communicates/reports information regularly to the Regional Operations and Compliance Officer. Ensures identified non-compliance detections are fully investigated, and a corrective action plan is developed and carried out by Affiliate Compliance Professional. Responsible for reporting non-compliance to Regional Operations Leadership. Acts as a project manager and ensures that appropriate timing, resources, and sequencing of work efforts are applied to create the project deliverables within a given timeframe and budget. Participates in the continual improvement of the regional compliance consulting services and implements changes on an ongoing basis to improve the prevention/detection of any non-compliance, as well as changes in needs of regional affiliates or managed sites, state/federal laws or regulatory requirements. Documents compliance consulting efforts and progress made in establishing methods and/or processes to improve the efficiency and quality of services and/or to prevent or reduce vulnerability to illegal, unethical, or improper conduct, fraud, abuse, and waste at Affiliate locations. Reports regularly to the Compliance Officer and Regional Operations Leadership team. • Responding to Reported Offenses Works collaboratively with all members of the Region Services Team and Affiliate partners to ensure all allegations of non-compliance are fully investigated and responded to promptly. Acts as a resource and liaison for external audits, compliance reviews, or investigations. Documents investigation efforts and progress made in establishing methods and/or processes to improve the efficiency and quality of services and/or to prevent or reduce vulnerability to illegal, unethical, or improper conduct, fraud, abuse, and waste. Reports regularly to Regional Operations Leadership team and Chief Compliance Officer. Provides assistance and consulting support for regional Affiliates. • Discipline & Accountability Works with Regional Operations Leadership team, Chief Compliance Officer, and Legal Counsel to report any instances of non-compliance to external agencies and/or regulatory entities as appropriate. Works with Regional Human Resources and Affiliate Human Resources to ensure a workforce with high ethical standards, including the establishment of minimum standards for conducting appropriate background and reference checks on potential employees. Supports the Regional Operations and Compliance Officer and other members of Regional Leadership as necessary to address non-compliant behavior. • Training Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements. Responsible for maintaining knowledge of relevant compliance issues, laws, regulations, and trends. Participates in the development and coordination of a multifaceted educational and training program that focuses on the elements of the Compliance Program and seeks to ensure that all employees, volunteers, affiliated professionals, contractors, regional affiliates/managed sites to ensure awareness and understanding of policies and protocols and to mitigate risk areas. Participates in the assessment and prioritization of the need for training and education. Shares knowledge and expertise within the Regional Services Team to promote cross-training, back-up, and general awareness. • Measuring Program Effectiveness Establishes and administers a process for documenting and tracking all complaints, actions taken, and any needed follow-up. Incorporates the use of technology and efficient workflow processes for creating documentation. Documents corporate compliance efforts and progress made in establishing methods and/or processes to improve the efficiency and quality of services and/or to prevent or reduce vulnerability to illegal, unethical, improper conduct, fraud, abuse, and waste. Reports regularly to Regional Operations Leadership and Chief Compliance Officer. • Information Systems Support Serves as the primary technology resource for implementing and developing compliance information systems (i.e., Compliance 360 modules, Protenus, PolicyStat etc.). Coordinates closely with regional Affiliates and software vendors to plan, analyze, design, implement, evaluate, and support compliance-related software solutions. Acts as a liaison and expert resource with the user community and software vendor to identify problems and concerns regarding the overall performance of the compliance information systems. Researches, analyzes, and makes recommendations and/or initiates corrective action to resolve problems with the internal functionality of the system and/or integration of information between systems. Provides the software vendor with recommendations for system enhancements, detailed information regarding technical or functionality problems and coordinates implementation of recommended fixes received. • General Duties Utilizes performance improvement principles to assess and improve quality particularly as it relates to the processes in the areas assigned. Utilize operational excellence tools. Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements. Maintains/builds an outside network of colleagues. Maintains competency in all organizational, departmental, and outside agency environmental, employee, or patient safety standards relevant to job performance. Performs other duties as assigned or needed to meet the needs of the department/organization. May conduct other special projects as assigned.