Primary City/State:Phoenix, Arizona
It is Banner Health's responsibility to implement and maintain an effective Compliance Program in adherence to the United States Department of Health and Human Services Office of the Inspector General to minimize the risk of regulatory or legal action against Banner. The Ethics & Compliance Department is responsible for developing, implementing, and overseeing all aspects of Banner's Corporate Compliance Program.
As the Compliance Audit Director, you will be responsible for assisting the Compliance Audit Senior Director develop, implement, and oversee all aspects of Banner's compliance program auditing and monitoring activities, particularly with respect to Banner Health's hospitals. You will have the opportunity to manage internal and external audit activities, as well as responding to external investigations.
Your pay and benefits are important components of your journey at Banner Health. This opportunity is also eligible for our Management Incentive Program, as part of your Total Rewards package. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life.Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.
This position provides analytical support for the organization's compliance functions which include assuring billing and business practices conform to federal, state, and local laws, regulations, and policies. Plans, coordinates and manages audits, monitoring activities, and third-party investigations and litigation Communicates the results of audits effectively, providing meaningful recommendations and feedback to management to strengthen the compliance culture of the organization. Works cooperatively with the organization's compliance leadership, other auditors (internally/externally) and operational departments to ensure the timely completion of audits and the development of corrective action plans.
1. Assists Compliance Audit Sr. Director and other relevant personnel in the process of assessing organizational compliance risk. Based on the assessment an annual compliance audit plan is developed which appropriately allocates audit resources to the areas of greatest compliance risk to the organization. Coordinates, plans, and executes audits by working with managers and appropriate staff to develop audit programs that document, assess, and monitor compliance with applicable requirements.
2. Contributes to the system-wide compliance audit and monitoring functions by directing related activities. This includes directing investigations and monitoring compliance activities in accordance with compliance program standards, policies and procedures. Reviews and ensures compliance with federal and state regulations imposed by government agencies, governmental contracts and others. Advises on audit controls for internal processes ensuring appropriate measures are in place for accurate, complete and compliant programs throughout the system. Proactively identifies areas throughout Banner where there may be opportunity to mitigate risk and responds accordingly in a timely fashion, including encouraging local reporting of potential issues.
3. Coordinates and manages externally contracted audits as needed to assure completion of the annual compliance audit work plan. Provides initial education to external auditors to ensure their understanding and adherence to Banner compliance audit standard operating processes and related policies & procedures. Provides quality review to ensure reliability and accuracy of the audit services completed by external contracted audit groups.
4. Communicates the audit plan and process so those being audited understand the requirements and expectations. Listens effectively throughout the audit process in order to understand. Communicates results through reports and exit conferences that strengthen the effectiveness of the compliance program. Facilitates and/or provides training as required to correct problems identified during audits. Assists facilities/medical groups in the development of corrective action plans based on audit results and conducts follow up audits where needed.
5. Oversees the thorough documentation of all compliance audit related activities for the system to ensure compliance with federally mandated reporting requirements. Ensures reporting requirements are maintained in a timely and accurate fashion for the system, including the resolution of each audit issue identified and closed. Reports on matters of business ethics, legal compliance and operations of the program. With minimal supervision, is responsible for writing any and all related documents, reports, executive and Board presentations. Able to provide professional presentations, training sessions, reports and updates to Banner board members, committees, executive leaders, regional and facility leaders, as well as the community.
6. Supports the compliance program leadership throughout their assigned facilities, divisions or areas, including providing ongoing support in the development of specific compliance goals and objectives. This position also acts as a resource to compliance management as needed or requested to address and resolve compliance related issues. Participates in various system committee meetings at appropriate levels based on the need and direction of the Sr. Dir. Compliance Audit.
7. Maintains a current awareness of compliance-related laws and regulations, keeping abreast of current changes that may affect health care systems through personal initiative, seminars, training programs and peer contact.
8. This position may supervise audit staff. This includes directing personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training and personnel evaluations.
9. Internal customers include senior management, physicians and all staff. External customers include State and federal agencies.
Must possess a strong knowledge of business and/or healthcare compliance as normally obtained through the completion of a bachelor's degree in business administration, accounting/finance, or health care related field. Positions with Pharmacy Audit accountability require a degree in Pharmacy from an accredited College of Pharmacy and current Pharmacy Licensure.
Requires knowledge of laws and regulations pertaining to health care, regulatory compliance, payer or physician billing and information systems, Medicare/Medicaid and financial reimbursement systems.
Must possess strong planning skills and problem solving skills. Must possess strong oral and written communication skills to effectively interact with senior management team, physicians and federal and state governing bodies. Must also possess highly effective negotiating skills to communicate and interact with senior management team and physicians.
Masters Degree preferred; previous health care/payer compliance experience preferred; minimum three years of healthcare management experience preferred. Additional related education and/or experience preferred, such as being certified as a Registered Health Information Technician (RHIT), Certified Professional Coder (CPC or CPC-H), or Certified Coding Specialist (CCS or CCS-P) or other relevant healthcare field.
Additional related education and/or experience preferred.
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