Compliance Official

Employment Type

Full time

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Shift

Day Shift

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Description

The PHSO Compliance Official serves as the ACO Compliance Officer and is responsible for providing oversight of business operations and working under the direction of PHSO Leadership to perform various activities to support the ACO Compliance program and CMS operational requirements. She/he will work collaboratively with the MercyOne Operations Team to provide oversight to PHSO colleagues related to compliance and contracting, among other functions.

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The PHSO Compliance Official serves as the ACO Compliance Officer and is responsible for providing oversight of business operations and working under the direction of PHSO Leadership to perform various activities to support the ACO Compliance program and CMS operational requirements. She/he will work collaboratively with the MercyOne Operations Team to provide oversight to PHSO colleagues related to compliance and contracting, among other functions.

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Business Operations Functions

• Administers MercyOne’s CMS-based Shared Savings/ACO Programs (e.g., Medicare Shared Savings Program (MSSP)) with complete accuracy, including but not limited to management of CMS authorization processes, participant and business entity registration, CMS applications, management of shared savings terms.
• Manages MSSP agreements with provider groups and post-acute partners, including new entrants or changed business entities. 
• Serves as an SME to Quality Payment Program (QPP) and CMS reporting requirements (e.g., Merit-Based Incentive Payment System (MIPS), promoting interoperability (PI)) 
• Assists with communicating and enforcing CMS reporting requirements (e.g., QPP, MIPS, PI) to ACO participants, including documentation of completion, and supporting ACO participants in resolving reporting issues.
• Communicates with ACO participants on collection of administrative fees. 
• Supports the development and maintenance of relationships with third-part vendors. 

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Compliance Functions

• Serves as ACO Compliance Officer.
• Interprets new program/federal regulations to assess enterprise compliance risk (e.g., impact to existing policies and processes and/or newly needed Policy and Procedures documentation) and implements changes as needed. 
• Manages and monitors electronic Policy and Procedure handbook, including facilitating policy review/renewals. 
• Manages regulatory documents with Payers, including CMS HPMS, CMS Data Use Agreements (DUAs), among others. 
• Facilitates and/or completes Corrective Action Requests, as needed, in response to governmental programs. 
• Maintains current knowledge of state and federal regulations/standards, research grants and federal funding requirements (e.g., audits), and other regulatory requirements.
• Monitors, evaluates and makes recommendations consistent with the various regulatory agencies to ensure PHSO documentation and activities are compliant.
• Ensures PHSO board governance is registered and compliant with CMS requirements, including public-facing reporting. 
• Ensures PHSO staff compliant use of electronic medical records and patient health information (PHI), including overseeing documentation audits according to federal and state health statutes, as well as third party control provisions.
• Works with regional chapter leaders, value based Participants, providers, and staff to enforce PHSO Policies & Procedures and CMS compliance requirements. 
• Performs business analysis to identify and trend areas of compliance and provides reports regarding areas evaluated.
• Evaluates and responds to inquiries from governing bodies/regulatory agencies (i.e.: CHAN, CMS)
• Acts as a liaison between MercyOne PHSO Administration, ACO Participant Organizations and ACO Chapters, including attending various committees and meetings to coordinate changes in PHSO processes, structural changes and strategic decisions.
• Utilizes effective problem solving skills in identifying strengths and weaknesses, identifying obstacles to progress and creatively defines problem solving approaches.
• Submits status reports toward project goals as requested.
• Appropriately escalates issues that may compromise or adversely impact project timelines, goals, or budget.
• Builds and promotes effective working relationships with multiple organizations and PHSO Chapters
• Performs other duties as assigned or as necessary.

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Knowledge & Skills

• Demonstrates knowledge of regulatory rules and or interpretation.
• Work requires a professional level of knowledge in health care (i.e. nursing, coding, billing)
• Proficient in use of computer applications, i.e. MS Office programs. 
• Demonstrated interpersonal skills including the ability to manage conflicts and disputes with contracted entities and stakeholders
• Proven ability to collaborate and work effectively across a large organization, able to handle a variety of issues, handle multiple tasks and simultaneously thrive in an environment with multiple competing priorities

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Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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