Arizona Community Physicians (ACP) is seeking a talented professional to join our successful medical group as our Corporate Compliance Director.
ACP is the largest physician-owned, predominantly primary care, medical group practice in southern Arizona, with over 900 employees and clinical offices located in 50+ locations of varying sizes.
We also have two imaging facilities, a testing center, a laboratory as well as a successful accountable care organization, Abacus Health.
We are seeking an experienced Compliance Director, preferably with clinical patient experience, to join our executive management team.
Reporting to the CEO and Medical Director of Compliance, this position will oversee the compliance program and will serve as a trusted consultant in helping ACP with compliance and risk management needs.
Successful candidates will need to be highly organized and have strong judgment to prioritize work and manage crisis situations. Also important is having knowledge of compliance laws and regulations with the ability to successfully navigate through patient and business needs as required.
Responsible for implementing ACP and its’ ACO subsidiary Abacus Health corporate compliance programs, overseeing and conducting coding and compliance risk assessments, and providing for education on appropriate coding and documentation requirements. Partners with operations and provider offices to navigate risk management concerns involving clinical practice.
1. Partners with the Medical Director of Compliance to recommend and implement corporate wide compliance programs.
2. Organizes and contributes in monthly compliance meetings. Also attends and participates in Board meetings.
3. Reviews all regulatory complaints from the Arizona Medical Board, DEA, CMS, and any other regulatory audits, as well as payor and patient complaints. Ensures timely and accurate responses to the regulatory agency. Notifies the Executive Director and Medical Director of newly served malpractice actions.
4. Educates providers on appropriate coding and documentation to ensure full compliance with all regulations. Works with providers to develop charting templates to ensure proper documentation.
5. Conducts compliance reviews and meets with providers to present audit results and recommendations for improvement.
6. Conducts new provider orientation for all new providers on compliance and OIG physician practice topics, Arizona controlled substance regulations, provider specific policies/ clinical practice guidelines/risk management resources, and appropriate use of CPT-4 codes, ICD-9 codes, and documentation.
7. Oversees employee HIPAA training; consults on subpoenas and medical record requests, partners with operational and clinical site to manage and mitigate HIPAA breaches, and files OCR breach reports.
8. Serves as a resource to all departments on compliance, regulatory, and risk management issues and identifies areas of risk.
9. Provides support to providers in managing difficult patient encounters.
10. Works closely with the Patient Accounting Department on all questions and concerns related to reimbursement, documentation, and rebilling of denied charges.
11. Stays up-to-date on impending regulatory changes and determines impact to the group.
12. Receives and processes compliance complaints from third party insurers, licensing boards, patients, staff, and providers. Manages the 24/7 compliance hotline.
13. Review, write and update policies for compliance, credentialing and other related business needs as required.
14. Assists in reviewing service contracts for conformance with regulatory and delegated provider requirements, as well as non-disclosure/business associate/ and affiliation agreements.
15. Other duties as required.
Minimum Job Requirements
1. Bachelor’s Degree
2. Three years’ experience in healthcare compliance programs with a large medical group or facility including knowledge of procedure coding and medical documentation
3. Proficient computer skills, including working knowledge of Epic EMR systems, physician billing systems, Microsoft Office Suite, e-mail systems, and other web based programs
4. Knowledge of regulations governing physician medical practices, medical coding, and documentation
5. Strong communication skills (written and verbal), and the ability to successfully interact with a variety of people in one-on-one meetings, group meetings, and presentations
6. Exceptional skills in confidentiality
7. Preferred: clinical patient experience; RN License and/or Certified Professional Coder; legal background; experience working in risk management