12/26/2014 11:45:00 PM
The Compliance Manager is responsible for working with the LCA Executive Leadership Team, the LCA Board of Directors, and the clinical operations team to ensure that clinical services offered in Comprehensive Refractive Solutions (CRS) sites of operation, and managed by LCA, are consistent with the Compliance Program. The Compliance Manager ensures compliance with all applicable federal and state laws and regulations, including but not limited to Medicare rules and regulations.
Essential Job Functions
• Develop and implement the Compliance Program for CRS which are managed by LCA.
• Provide compliance oversight and guidance to the LCA Board, Executive Leadership Team, LCA clinical operations team, LCA Regional Directors, Medical Eye Associate Boards, and CRS Center Directors and staff managed by LCA relative to the opening of new CRSs and ongoing operations.
• Coordinate with LCA Legal / Risk / Human Resources / Training to address questions and resolve issues relating to compliance requirements.
• Direct compliance efforts with LCA quality assurance and credentialing initiatives.
• Develop, plan, and provide compliance training and compliance programs specific to CRS. Such education will be provided at the opening of a new CRS location and on a regular basis thereafter.
• Work with Internal Audit Department to prepare annual compliance risk assessments and develop annual compliance audit work.
• Implement and update forms, policies, and other compliance related materials as needed.
• Coordinate with LCA Risk/Legal to ensure that all written agreements with providers, suppliers, and third party payers are compliant with the Compliance Program, applicable company policies and relevant healthcare laws and regulations, including Medicare regulations, Stark law and Anti-kickback statute.
• Evaluate compliance concerns and reports of suspected misconduct and perform and/or oversee investigations in conjunction with Risk / Legal / Human Resources, to ensure that all suspected violations of the Compliance Program are fully investigated and resolved.
• Develop, monitor, and report on any corrective action plans.
• Prepare regular reports to the LCA Executive Leadership Team, LCA Board of Directors describing compliance activities.
• In conjunction with Legal, ensure that Center Directors are advised of relevant state law requirements.
• Monitor the activities of providers of contracted services, e.g. third party billing services, and other vendors to ensure compliance with the Compliance Program.
a. Review CRS roll-out plans and actively participate as a team member to ensure communication is clear and disseminated to Regional Directors.
b. Identify issues and recommend resolution to Operational problems associated with CRS integration with LASIK business protocols and procedures.
c. Advise, recommend and influence implementation of any identified best practice.
d. Assist Regional Directors and Training Managers in the identification of training requirements that may be observed during any vision center visits (CRS and LASIK).
a. Develop LASIK and CRS Quality Assurance program.
b. Analyze patient complaints and outcome data for trends requiring intervention programs.
c. Develop intervention programs and manage the implementation of such programs across the network.
d. Ensure policies and procedures are aligned and promote exceptional outcomes and reduce risk.
• At least 10 years in a healthcare setting, preferably ophthalmology, with experience in compliance and/or in management in operations, finances, billing and reimbursement. Must possess a thorough understanding and knowledge of healthcare legal and regulatory practices, billing, coding, documentation and conditions of participation for health care programs (particularly Medicare), financial and internal control systems and/or procedures.
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• Must possess strong problem solving, conflict management and consensus building skills. Must be capable of serving as an advisor with the flexibility and pragmatism to work in an unstructured environment.
• Must have the ability to work as part of a team. Must have the skill and confidence to operate without daily supervision.
• Must be comfortable in a collaborative, shared leadership environment. Must be able to adapt to frequently changing work priorities and emerging issues.
• Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others.
• Demonstrates strong interpersonal skills and excellent communication skills both written and verbal, as well as exhibiting strong organizational skills and work ethic.
• Must take proactive steps to stay current with changing laws and regulations that impact CRS and LASIK business practices. Certifications must be kept up-to-date.
• Significant travel will be required.