at Option Care Health in Chicago, Illinois, United States
Job Description
Extraordinary Careers. Endless Possibilities.
With the nation’s largest home infusion provider, there is no limit to the growth of your career.
Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 6,000 team members including 2,900 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees.
As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a thriving workforce that is as diverse as the patients and communities we serve.
Join a company that is taking action to develop a culture that is more inclusive, respectful, engaging and rewarding for all team members. We are committed to hiring, developing, and retaining a diverse workforce.
COVID-19 Vaccine Requirements:
As a leading healthcare provider, we have an undeniable responsibility to protect the health and safety of our patients, customers and team members.
Option Care Health requires that all employees be fully vaccinated against the COVID-19 virus. If you are offered and accept a position, your employment will be contingent upon proof of vaccination, or approved medical or religious accommodation. Proof of vaccination will be required during the onboarding process; application for medical or religious accommodations will be required to be submitted within 5 business days of start date. If medical and/or religious accommodation requests are denied, you must take steps to be fully vaccinated, or your employment will be terminated.
Job Description Summary:
The Senior Manager, Compliance Auditing, Monitoring and Analytics is responsible for overseeing and conducting the Compliance program’s risk-based auditing, monitoring and analytics activities to monitor, assess, and optimize our compliance with all laws, regulations and guidelines with Federal and State programs. This role requires a strong understanding of healthcare regulations, exceptional auditing and analytical skills, and the ability to communicate complex findings effectively to stakeholders at all levels of the organization.
Reporting to the VP, Compliance & Privacy Operations, this individual develops and executes monitoring and auditing projects, to include standard, repeatable processes identifying, documenting and presenting any errors, irregularities or findings, and completion of necessary corrective actions. Partners with functional leaders and field teams to coordinate audit and monitoring activities from initiation through completion of corrective action. Serves as a resource both internally and externally regarding compliance-related issues, including the coordination of regulatory, payer or other audits. Designs and implements robust analytics and continuous monitoring strategies to prevent, detect and mitigate compliance risks. Manages and develops Compliance team members.
Job Description: ?
Job Responsibilities (listed in order of importance and/or time spent)
+ Develop and implement a risk-based compliance auditing, monitoring and analytics program to assess the effectiveness of compliance controls and processes across the organization in alignment with the Compliance organizations risk assessments and workplans.
+ Conduct periodic compliance audits and reviews in accordance with established Compliance workplans, focusing on key risk areas such as regulatory changes, billing and coding, privacy and security, and fraud and abuse. Coordinates with internal stakeholders to identify audit objectives, scope, and methodologies, and ensure alignment with organizational priorities.
+ Perform data analysis and review of documentation to identify potential compliance issues, irregularities, or trends, and develop recommendations for corrective actions or process improvements.
+ Monitor compliance with policies, procedures, and regulations through ongoing monitoring activities, including data analysis, trend analysis, and review of key performance indicators.
+ Collaborate with cross-functional teams to implement corrective actions and remediation plans in response to audit findings, and track progress to ensure timely resolution. Identifies policy, procedure, and process gaps and partners with functional leaders to develop responsive corrective measures to prevent reoccurrences.
+ Provide guidance and support to staff members on audit and monitoring processes, including training on audit techniques, tools, and methodologies.
+ Prepare and present regular reports on audit and monitoring activities, findings, and outcomes to executive leadership and regulatory authorities as required.
+ Stay informed of changes in healthcare laws and regulations, industry standards, and best practices related to compliance auditing and monitoring, and incorporate updates into audit plans and processes.
+ Maintain documentation of audit and monitoring activities, including work papers, findings, recommendations, and corrective actions, in accordance with established recordkeeping requirements.
+ Escalate and report serious compliance, quality or other business risks timely to functional leadership by demonstrating the ability to exercise good independent judgment in assessing the significance and relevance of identified issues.
+ Collaborate with cross-functional teams to develop and implement analytics-driven, risk-based capabilities to continuously monitor compliance with internal policies and federal, state, and local regulations. Utilize advanced analytics techniques to analyze large datasets, such as related to healthcare operations, billing, claims, and patient information to support Compliance activities and to identify trends, anomalies, and potential compliance risks.
+ Respect and maintain the confidentiality of sensitive business and patient information at all times. Maintain files and work papers consistent with Option Care Health policy and Compliance processes at all times.
+ Develop and revise compliance policy and procedures related to auditing and monitoring activities. Support Compliance leadership in risk assessment, work planning and budgeting activities.
+ Effectively collaborate on integrated reviews and process assessments with other functions, such as Legal, Internal Audit, Quality & Risk Management, Revenue Cycle Management, Information Security, Human Resources, Operations, etc.
+ Manage and partner with external professional services organizations engaged to conduct compliance audits and monitoring activities to support successful completion of such initiatives. Also coordinate with external and internal auditors and internal stakeholders to foster understanding and provide required documentation, correspondence, responses, information or other follow up as needed.
+ Develop and maintain relationships with external partners, such as regulatory agencies, industry associations, and legal counsel, to stay informed of emerging compliance trends and best practices.
+ Provide ongoing direction, management, coaching and development to Compliance staff and foster a team culture of diversity, inclusion, connectivity and professional growth.
+ Stay abreast of changes in healthcare regulations, industry trends, and best practices in compliance analytics, and proactively identify opportunities to enhance compliance processes and systems.
+ Supports compliance and privacy integration initiatives with new business models.
Supervisory Responsibilities
Does this position have supervisory responsibilities? Yes
(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, et
