Manager - Corporate Compliance - Media, PA

Reference #: 5001101880310

BackManager - Corporate Compliance#ELW-20300 | Posted 02/17/2025

Multiple Locations + 2 more

ApplyManager - Corporate Compliance#ELW-20300 | Posted 02/17/2025Multiple Locations

+ 2 more

Apply for this job now! ApplyJob DescriptionAbout Elwyn - Since 1852, Elwyn has helped people with autism, intellectual, developmental, and behavioral challenges lead meaningful lives. As an internationally recognized nonprofit human services organization, we have always been on the forefront of innovation.Please join us to make a difference in the life quality of children, teens and adults with autism, intellectual and developmental disabilities, and related behavioral health challenges - and feel the resulting pride that will enrich your own life.Providing an excellent benefits package is another way we know that Elwyn is truly a special place to work. We invest in your future while you help care for ours:

Generous Paid Time OffComprehensive Medical/Dental/Vision Benefit PackagesEarned Wage Access/On-Demand Pay

Paid On-the-Job TrainingTuition ReimbursementCareer Advancement Opportunities and GrowthFlexible SchedulesRetirement Savings Plan

Elwyn is currently seeking a Corporate Compliance Manager (CCM) who works independently to develop strategies that drive the completion of compliance projects, audits, and other planned activities assigned by the Corporate Compliance and Privacy Officer; monitors applicable regulatory changes and updates organizational policy and procedure accordingly; compiles, tracks, and updates the status of significant issues reported for guidance or investigation to Elwyn's Corporate Compliance Department; analyzes, measures, and tests specific compliance risks against existing organizational controls; and reviews claims and remittance data and reports on the status of Elwyn's compliance with state and federal payment policies. The CCM understands and can train others on basic safeguards and practical application of the Health Insurance Portability and Accountability Act (HIPAA), regulations administered under the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Family Educational Rights and Privacy Act (FERPA) privacy laws. Through critical thinking, resourcefulness, collaboration and problem-solving skills, the Corporate Compliance Manager serves as an important contributor in the overall effectiveness of Elwyn's Corporate Compliance Program.

DUTIES AND RESPONSIBILITIES

Develop compliance strategies, including but not limited to contributing to the structure of operational areas to prevent potential violations of policy and misconduct, and execute strategies and plans to completion by assessing and monitoring legal and regulatory risks to ensure that the company's activities comply with applicable laws and regulations

Monitor and assess the performance of the corporate compliance program and related activities on a continuous basis, through auditing and analyzing data. and coordinating regularly with the Corporate Compliance Officer to use findings and outcomes for the improvement of program effectiveness

Maintain awareness of relevant industry developments pertaining to reimbursement and legal compliance, through actively seeking out and studying relevant bulletins, alerts, and notices, and informing operational areas (e.g. service line leaders, revenue cycle management, payor contracting, finance etc.) to ensure that practices are consistent with payment integrity regulations and with industry best practices

Develop periodic risk-based audit objectives for the services provided including performing period claim reviews to verify sufficiency of the clinical service records to reconcile the claim submitted and revenue remitted

Provide quarterly reports summarizing the results of audits performed for the compliance officer, revenue cycle management, and the service line leaders to highl ght potential compliance issues and billing errors

Consult with internal leadership, as needed and appropriate, to resolve corporate compliance issues, including but not limited to deficiencies identified through regulatory compliance risk assessment(s), auditing and monitoring confidential hotline reports, and contributing to the development and execution of plans of correction for specific identified issues

Develop and present reports that keep the Corporate Compliance Committee and senior management informed about the progress of risk assessments, data analysis and audits to ensure tracking of open issues and that compliance activities are visible to key stakeholders on a regular basis

Collaborate with the Corporate Compliance Officer, General Counsel, and Human Resources to periodically review and update the Code of Conduct to ensure its continued relevance with the workforce and effectiveness in the current regulatory environment

Initiate, as appropriate, the development of effective compliance training including appropriate introductory training for new employees and ongoing training for all employees and managers in the company's culture of ethical business practices, prevention and reporting of financial fraud risks, and data privacy and security to ensure staff awareness of current laws and/or regulations applicable to their job function and the industry

Perform other duties as assigned

EDUCATION/SKILLS/EXPERIENCE REQUIREMENTS:

Bachelor's degree in healthcare administration, social work, human services, finance, accounting, or related field; equivalent years of directly relevant experience in healthcare privacy and compliance can substitute for undergraduate degree

Three (3) years of experience in healthcare privacy and compliance

Experience related to auditing healthcare services is strongly preferred

Demonstrated working knowledge of Medicare/Medicaid regulations

Demonstrated excellent analytical and problem-solving skills, and judgment with specific application to medical and financial data

Demonstrated ability to anticipate future needed changes or identify problem areas and take effective actions

Ability to manage and prioritize multiple competing priorities

Demonstrated excellent judgment with the ability to independently solve problems and make decisions with minimal supervision

Demonstrated intermediate working knowledge with Microsoft Office applications, including Word, Excel, and Outlook

Non-profit human service experience highly preferred

Demonstrated ability to work effectively as part of a team

Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities

Demonstrated strong attention to detail

Demonstrated strong time management and organizational skills

Experience using/knowledge of Electronic Health Record (EHR) / Electronic Medical Record (EMR) preferred

Must possess excellent customer interaction, collaboration, presentation, and written and verbal communication skills

PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment conditions to which the employee holding this position must meet, in addition to the duties and responsibilities listed above, to successfully perform the essential functions of this job. Elwyn will engage otherwise qualified candidates for this position whose disabilities may require reasonable accommodations to enable an individual to perform the essential functions.

Elwyn reserves the right to revise or change job duties and responsibilities as needed. This job de