CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Job Summary / Purpose The position advances proactive efforts to ensure applicable Federal and State laws and regulations related to physician self-referral (Stark law), Anti-kickback statute, fraud and abuse, and tax exemption are met. Manages activities to help identify and address issues as well as promote awareness through guidance and education. Assists with compliance investigations, monitoring activities, and other projects as necessary. Responsible for continuous improvement of the compliance program and implementing program enhancements as needed.
The position requires an in-depth understanding of physician related operational and business practices and the various laws and regulations governing physician relationships in healthcare. This position is extremely knowledgeable in hospital and physician practice operations and fosters an ethical and compliant culture while supporting the organization's operational strategies and goals.
Essential Key Job Responsibilities Identifies opportunities and advances proactive efforts to ensure applicable Federal and State laws and regulations related to physician self-referral (Stark law), Anti-kickback statute, fraud and abuse, and tax exemption are met. Manages centralized processes ensuring consistency and accuracy for activities related to non-monetary compensation tracking, physician conflicts of interest, physician owned entities, marketing/advertising review, and other applicable activities in accordance with company policy. Supports efforts to ensure physician arrangements are operationalized as written. Assists with Physician Arrangements Review process activities and data analysis and reporting as requested. Provides guidance and ongoing education. Develops and provides tools to assist operators ensure compliance. Assists with compliance investigations, monitoring activities, and other projects as necessary. Assists with monitoring activities and development of corrective action plans as requested. Assists with physician relations due diligence and organizational integration work efforts involving both growth and divestiture activities as requested. Stays apprised of governmental enforcement efforts, the current regulatory landscape, and associated risks. Represents corporate responsibility on various system and region committees and workgroups as requested. Works closely with regional and market leaders and corporate responsibility officers. Works closely with legal counsel to ensure proper interpretation of the applicable laws and regulations. Required Education and Experience Bachelor's Degree required. Minimum of five (5) years' experience in healthcare regulatory or operational compliance. Leadership experience preferred. Required Licensure and Certifications One of the following is preferred upon hire or required within the first year of employment: Certified in HC Compliance (CHC), Certified Compliance and Ethics Professional (CCEP). Required Minimum Knowledge, Skills, Abilities and Training Experience managing risks related to the various laws and regulations governing physician relationships in healthcare, both for employed and non-employed physicians. In depth knowledge of Federal and State laws and regulations related to physician self-referral (Stark law), Anti-kickback statute, fraud and abuse, and tax exemption. Success with identifying and resolving operational issues. Success working collaboratively with other discipline leaders to accomplish goals. Excellent problem-solving skills System-thinking, considering widespread effects of decisions and actions Strong knowledge on physician arrangements compliance and basic understanding of healthcare billing and coding compliance. Ability to collect, organize and analyze data and information, Financially literate. Ability to work independently while managing multiple complex projects simultaneously.
