Officer, Ethics & Compliance

Organization:

SHSO-Sutter Health System Office-Valley

Position Overview: 

Administers and provides oversight of the Sutter Health Ethics and Compliance Program, addresses risk related to business ethics and compliance requirements, and ensures all policies, processes, and practices adhere to expectations of the Federal Sentencing Guidelines, HHS Office of the Inspector General and the HHS Department of Justice. Manages the design and implementation of strategies, policies, processes, and tools that facilitate effective and efficient compliance practices, observe and report actual or potential violations, establish and track training requirements, and monitor the progress of corrective actions. Investigates and maintains documentation of ethics and compliance incidents and ensures timely reporting to government entities as required by law. Develops and conducts periodic risk assessments, monitors key elements of the Ethics & Compliance program, and ensures implementation of training programs for members of the affiliate's workforce and physicians. Ensures the alignment, standardization, and effectiveness of compliance activities across the affiliate, operating unit (OU), and system levels. Participates in the development and delivery of a training strategy that addresses both general and specific (role-based) compliance education needs, that provides up-to-date information on current legal, regulatory and Sutter Health policy requirements, and that builds awareness of the program, processes, and potential legal ramifications of noncompliance. Provides insights regarding regulatory changes, trends, areas for potential risk, and process gaps, and offers compliance guidance and reporting to senior management and governance boards.

Job Description:

The candidate selected for this role must be a commutable distance from Sacramento and must come on site for work, meetings, etc.

We cannot accept a candidate from out of the area, or out of state.

This role will support Sutter Medicare Direct and the Comprehensive Health Assessment (CHA) Program.

EDUCATION:
Equivalent experience will be accepted in lieu of the required degree or diploma.

Bachelor's: Business, Healthcare, Informatics, Pre-Law, Project Management, or related field or equivalent education/experience


CERTIFICATION & LICENSURE:
CHC-Certified in Healthcare Compliance (for Revenue Cycle, CHC required within 1 year)

TYPICAL EXPERIENCE:
12 Years of recent relevant experience.

SKILLS AND KNOWLEDGE:
Expertise in managing an effective ethics and compliance program, including: infrastructure development; policy management; training; monitoring/auditing; conducting and documenting investigations; addressing and resolving violations, errors, and deficiencies; tracking corrective actions, performing risk assessments, and designing strategies to prevent future compliance problems.

Detailed understanding of healthcare compliance standards, compliance program development and assessment, relevant healthcare operational issues, business ethics and compliance risks and the knowledge to effectively manage those risks in a dynamic healthcare environment.

Comprehensive knowledge and understanding of current regulations that govern healthcare operations, including the California Knox-Keene Act, California Insurance Code, Office of Inspector General (OIG) Work Plan, Affordable Care Act and Health Insurance Portability and Accountability Act (HIPAA) regulations, in addition to federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), Internal Revenue Code, Employee Retirement Insurance Security Act (ERISA), Americans with Disabilities Act, privacy and consent laws, and licensure requirements, and quality standards.

In-depth knowledge of federal and state regulatory filing and reporting systems: national Association of Insurance Commissioners (NAIC) System for Electronic Rate and Form Filing; California Department of Managed Healthcare (DMHC) eFiling web portal; Centers for Medicare and Medicaid Services (CMS) Enterprise Portal; Health Insurance Oversight System (HIOS) Portal; Rates and Benefits Information Systems (RBIS).

Well versed in current and emerging business ethics and compliance topics, project management methodologies and tools, resource management and change management techniques.

Working knowledge of other disciplines outside own area of expertise, including business planning, clinical disciplines, human resources, finance, clinical and financial auditing, and information technology.

Strong organizational skills with an excellent understanding of team building and organizational dynamics, including creative problem identification and resolution, conceptualization, and contingency thinking skills.

Advanced project management skills, including the ability to facilitate and manage multiple complex projects simultaneously while efficiently and effectively achieving objectives.

Superior attention to detail, superior analytical and strategic planning skills with the ability to identify potential issues/risks/trend, analyze data, provide insights to staff and affiliates, and recommend actions to resolve or minimize the impact.

Excellent verbal and written communication, interpersonal, and presentation skills with the ability to explain complex legal and regulatory requirements directives, ideas, and concepts clearly and professionally to diverse audiences and all levels of internal/external leadership.

Competency in Microsoft Office suite (Word, Excel, PowerPoint), including a working knowledge of data management to interpret information and track results, and internet-based legal and regulatory research.

Ability to
• translate complex legal and regulatory requirements into lay terms and provide cogent advice to senior management regarding the impact of compliance enforcement, legislation and regulations on affiliate business strategies, and its not-for-profit mission.
• convert a vision into a strategic and actionable plan with clear ethics and compliance goals and objectives.
• adapt to changing or challenging initiatives while developing new ideas and approaches aimed at improving results.
• foster a collaborative environment, to influence individuals or groups with diverse opinions and to enlist cooperation without direct control/authority.
• maintain strict confidentiality of all compliance and risk management data, and ensure the privacy of each patient’s protected health information (PHI).
• build and maintain collaborative relationships with peers, other departments, stakeholders, consultants, government agencies, and external organizations to achieve regulatory and accreditation compliance.

Pay Range:

The salary range for this role may vary above or below the posted range as determined by location. This range has not been adjusted for any specific geographic differential applicable by area where the position may be filled. Compensation takes into account several factors including but not limited to a candidate’s experience, education, skills, licensure and certifications, department equity, training and organizational needs. Base pay is just one piece of the total rewards program offered by Sutter Health. Eligible roles also qualify for a comprehensive benefits package.

Job Shift:

Days

Schedule:

Full Time

Shift Hours:

8

Days of the Week:

Friday, Monday, Thursday, Tuesday, Wednesday

Weekend Requirements:

None

Benefits:

Yes

Unions:

No

This position is work from home eligible.

Position Status:

Exempt

Weekly Hours:

40

Employee Status:

Regular

Number of Openings:

1

Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.