This system position provides the day-to-day oversight and management of the System's Corporate Responsibility Process (the "CRP") through robust implementation of the seven elements of an effective compliance program, including 1) the establishment of policies and procedures, 2) the development of compliance committees throughout the system, as needed, 3) employee training and education, 4) ensuring open lines of communication including the establishment of a hotline, 5) response to allegations including conducting investigations, 6) use of audits and other evaluation techniques to monitor compliance, and 7) remediation of identified issues and development of corrective actions. Additionally, this position provides support and assistance to the System Vice President, Corporate Responsibility in preparing necessary reports and content for the newly formed Audit and Compliance Committee of the Board and other system-level compliance committees. Interaction with all levels of the organization in a skillful and professional manner will be necessary as part of a total program to assure full understanding of compliance with ethical, legal, and regulatory policy, including facilitation of the full potential of continuous quality improvement processes to achieve these ends.
REPORTING RELATIONSHIPS:Reports to: System Vice President, Corporate Responsibility (Chief Corporate Responsibility Officer (CRO)Supervises:Regional Director, Corporate Responsibility- Missouri, Oklahoma and system hospital coding audits, System Director, Corporate Responsibility- Wisconsin, Illinois, Post-Acute Care and Medical Group coding audits, System CR Data AnalystInterrelationships:Interacts with system leaders including System and Senior Vice Presidents, regional and entity leadership, system office staff, external consultants (including attorneys and auditors), vendors, employees and physicians throughout the organization. PRIMARY RESPONSIBIliTIES AND DUTIES:
1. Imparts the mission, philosophy, values, and vision of SSM Health and facilitates the integration of values in CQI activities.
2. Understands, embraces, and practices the principles of CQI in utilizing the Malcolm Baldrige criteria as a means to achieve performance excellence.
3. Provides a personal example of CQI leadership by effectively applying the seven principles of the System philosophy and expectations (see executive handbook) to carry out the duties of this position.
4. Works effectively as a team member in a dynamic executive environment where collegiality, subsidiarity and sharing responsibility is highly valued in a matrix organization.
5. Incorporates the principles of continuous quality improvement whereby decision-making is driven by data, customer satisfaction is promoted and employee partnership is highly valued.
6. Responsible for facilitating activities which help ensure compliance with all laws and regulations, including Anti-Kickback, Stark, IRS, beneficiary inducement, HIPAA and state privacy laws, human subjects research, the code of conduct and conflict of interest policies, and coding and billing requirements.
7. Integrates fundamental System mission and values into the overall Corporate Responsibility Process, providing a philosophical and cultural context that frames any legal and regulatory requirements that must also be met.
8. In concert with and under the direction of the System Vice President, Corporate Responsibility, takes responsibility for implementing a state-of-the-art program of education about corporate compliance matters and facilitates the process for responding to a wide variety of corporate compliance issues through the development of appropriate system-wide policies and procedures.
9. Develops and administers routine policies and procedures necessary to carry out broader organizational goals related to compliance. Identifies emerging legal and regulatory issues that require development of new policies, revised processes, and focused education.
10. Facilitates the annual compliance Risk Assessment process to identify system wide focus areas that require follow-up to prevent non-compliance. Coordinates with applicable operational leaders to carry out the annual work plan.
11. Assesses and evaluates existing or proposed mechanisms for carrying out a corporate responsibility program such as rapid response processes, helplines, and other methods, making recommendations to the System Vice President.
12. Provides direction in the management of the CRP Helpline, protects the
confidentiality of the employee reporting a compliance matter and responds in a timely manner to all reported incidents. Coordinates with Human Resources on personnel matters which may be reported via the CRP Helpline.
13. In concert with the Chief Corporate Responsibility Officer and the system and regional Corporate Responsibility Committees, defines the periodic CRP monitoring and auditing initiatives, coordinates the implementation of these activities, and the reporting of significant findings or trends.
14. Conducts and/or coordinates internal investigations of alleged violations of law,
utilizing where appropriate, the SSM internal audit staff, general counsel staff, other departments as appropriate, and consultants. Determines the appropriate responses to the allegation and follows appropriate communication protocols. Interfaces with governmental personnel regarding external inquiries. Reports and consults with the Chief CRO as needed on significant issues.
15. Interacts with Contract Management, including discussions with legal counsel
and entity personnel on specific technical issues related to a specific contract, Business Associates Agreement process and issues addressed by the Contracts Approval Committee.
16. Staffs teams and committees, or ensures appropriate CR member staffing of such committees, for system, regions and entities where the issues pertain to corporate responsibility, including within hospitals, medical groups, post-acute care sites, and joint ventures, when applicable.
17. Prepares and submits regular reports on the activities of the Corporate Responsibility Process for review by both senior management and as directed, the Board of Directors or other operating bodies.
18. Represents the Corporate Responsibility function internally and externally through effective writing and speaking as required.
19. Consults to all areas of the organization such as, but not limited to, finance, marketing and planning, human resources, line operations, physician organization and managed care organization on all matters requiring a response to issues initiated through the Corporate Responsibility reporting and communication processes.
KNOWLEDGE, SKILLS AND ABIliTIES
KNOWLEDGE, SKILLS AND ABIliTIES:
Understanding the Mission and Values of SSM Health and the Franciscan
Sisters of Mary.
2. Understands, embraces and practices the principles in CQI.
2. Possesses or acquires knowledge of the philosophy and mission of SSM Health and
the philosophy of the sponsoring organization, SSM Health Ministries, and the
ability to support the belief and values contained therein.
4. Ability and desire to integrate CQI principles and tools into work processes.
5. Exhibits a very high degree of analytical; investigation and problem solving skill to evaluate information; to plan, organize and direct work of others; to develop short and long range goals.
6. Possesses an in-depth understanding of the key legal and regulatory requirements of health care provider with particular emphasis on the requirements for participation in the Medicare/Medicaid program and other governmental health benefits programs.
7. Retains or acquires a broad knowledge of regulatory, legal and operational aspects of health care delivery including patient care, medical staff, finance, planning, human resources, and marketing.
8. Comprehends principles of adult learning and applies them in the effort to achieve broad understanding and responsiveness to the Corporate Responsibility Process.
9. Exhibits superior interpersonal skills to interact effectively at all levels of the organization and externally to establish and maintain the highest possible credibility.
10. Strong communication skills, both verbal and written, are essential.
The above level of knowledge, skills and abilities are normally acquired through the completion of a graduate level program in Health Care or related discipline and ten or more years increasingly responsible experience in a health care environment, with at least five years in a compliance related role.
1. The working conditions are appropriate to carrying out the principal duties and responsibilities of a position requiring comfortable office surroundings.
2. Some travel and flexible hours appropriate to a leadership position in a multi- institutional environment's corporate office.
3. Non-smoking environment.
The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not to be construed as an exhaustive list of al job duties performed by the personnel so classified.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same