The Regional Director, Corporate Responsibility, under the direction of the SSM Health System Vice President of Corporate Responsibility, will oversee and monitor the organizations' Compliance and Corporate Responsibility Programs for SSM Health in Wisconsin, SSM Health in Southern Illinois, and SSM Health Post Acute Services. This includes the responsibility for planning, developing, implementing and coordinating systems to detect, correct and prevent potential problems of noncompliance within the entities and areas assigned. This position will carry out entity initiatives to ensure that commitment to these programs are communicated and adhered to throughout the various areas of responsibility, defined above.
1. Manages the day-to-day operations of the Compliance Program and serves as a focal point for compliance activities within SSM Health Wisconsin, SSM Health Southern Illinois and SSM Post-Acute Service. This includes the following care sites/services: In Wisconsin: SSM Health Dean Medical Group, SSM Health St. Mary's Hospital-Madison, SSM Health St. Mary's Hospital-Janesville, SSM Health St. Clare Hospital - Baraboo, St. Mary's Care Center, and St. Clare Meadows Care Center in Wisconsin. In Southern Illinois: SSM Health Good Samaritan Hospital in Mt. Vernon and St. Mary's Hospital in Centralia. In Post-Acute: System-wide Home Care and Hospice
2. Assists the applicable Regional Presidents/Administrators in establishing methods to improve efficiency and reduce vulnerability to fraud, abuse, and waste; and keeps them apprised of compliance related concerns as appropriate.
3. Develops and implements systems, policies and procedures to prevent, detect and correct instances of noncompliance, pursuant to SSM Health's Corporate Responsibility Process (CRP) and Federal and State regulatory requirements.
4. Provides oversight and leadership to Corporate Responsibility staff for SSM Wisconsin and Illinois which may include hiring, training, performance management and performance improvement plans. Ensures appropriate function coverage and cross training, along with documentation of department processes. Effectively communicates information to staff and delegates assignments as appropriate. Provides development opportunities to direct and indirect staff.
5. Annually review the OIG Work Plan and conduct a corporate needs assessment to formulate annual Compliance Work Plans.
6. Initiates, conducts, and/or coordinates internal and external audits and monitoring activities as necessary in order to ensure compliance with state and federal laws and regulations.
7. Ensures timely and appropriate investigation and response to all Compliance inquires from employees, patients, third parities and the Compliance Hot Line
8. Develops and coordinates a multifaceted educational training program focusing on compliance and HIPAA, as appropriate. This includes ensuring that independent contractors and agents who furnish medical services within the entities are aware of the requirements of the organizations' ethical conduct standards.
9. Works in conjunction with Human Resources and the Office of Medical Affairs to coordinate periodic background checks and Compliance related personnel issues, including HIPAA issues.
10. Ensures compliance with the financial disclosure and conflict of interest process.
11. Serves as Chair of the various Compliance Committees within the applicable regions of responsibility.
12. Maintain good working relationship and coordination with other Compliance offices at Dean Health Plan.
1. Provides developmental guidance and assists in the identification, implementation, and maintenance of information privacy policies and procedures in coordination with SSM Health Care and the Privacy and Security Committee. Manages the day-to-day operations of the Privacy Program and serves as a focal point for privacy activities within SSM Wisconsin Region.Works with Administration, legal counsel, Office of Civil Rights and related parties to represent SSM Health's information privacy interests with external parties (state or local government) who undertake to adopt or amend privacy legislation, regulation, or standards or participated in compliance reviews or investigations.
2. Performs periodic information privacy risk assessments and conduct related ongoing compliance monitoring activities in coordination with other compliance and operational assessment functions.
3. Work with key departments and committees to ensure that SSM Health has and maintains appropriate privacy and confidentiality authorization forms information notices and materials reflecting current organization and legal practices and requirements.
4. Participate in the development, implementation and ongoing compliance monitoring of all business partner and business associate agreements to ensure that privacy concerns, requirements and responsibilities are addressed.
5. Work cooperatively with the CIO, the Director of Health Information Services and Manager of Patient Advocacy and other appropriate departments in overseeing the patient right to inspect, amend and restrict access to protected health information when appropriate.
6. Establish and administer process for receiving, documentation, tracking, investigating, and taking action relating to all patient complaints concerning privacy and confidentiality.
7. Ensure compliance with privacy practices and consistent application of sanctions for failure to comply with privacy policies for all individuals in SSM Wisconsin's workforce, extended workforce, and for all business associates in cooperation with Human Resources, Chief Information Security Officer, administration and legal counsel.
8. Initiate, facilitate and promote activities to foster information privacy awareness and training.
9. Maintain current knowledge of applicable federal and state privacy laws and accreditation standards, and monitor advancements in information privacy technologies to ensure SSM Health's adaptation and compliance.
1. Bachelor's degree in business or health care related field with 10 years of relevant experience.
2. Broad knowledge and experience in understanding and working with federal and state health care regulatory and compliance standards, including HIPAA privacy and security.
3. High degree of interpersonal skills and problems solving abilities and excellent organization and communication skills.
4. Ability to demonstrate visionary planning and analytical reasoning skills.
5. Previous experience in regulatory compliance and developing and implementing major initiatives to maintain and improve performance considering regulatory standards.
6. Must possess a strong understanding of health care reimbursement as it pertains to local, regional and federal health care.
7. Must be a team player demonstrating leadership skills and the ability to proactively develop and direct solutions.
8. Must have a reputation for integrity and objectivity as an independent thinker willing to challenge management on issues arising through Compliance initiatives.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Ability to sit for extended periods while on the phone or computer.
2. Ability to see fine print and to use the computer for extended periods.
3. Ability to continuously perform fine motor tasks, such as computer, writing or phone tasks.
4. Ability to hear and converse on the phone and in person.
5. Ability to safely lift lightweight boxes or equipment weighing up to 20 pounds.
SSM Health - System Office –
SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God.