Job description
Description/Job Summary:
The Compliance & Regulatory Senior Manager will be responsible for supporting operations of the compliance department, including planning, and coordinating departmental initiatives, to ensure adherence to regulatory standards and best practices. The Senior Manager will directly supervise the Compliance Regulatory Specialist. The Senior Manager will also assist with leading a team of Compliance and Regulatory Managers in monitoring programs for compliance, completing and overseeing investigations. The Compliance & Regulatory Senior Manager will assist with coordination and manage compliance efforts to ensure RHD meets with federal and state laws, funder regulations and contracts, and RHD Policies related to the provision and billing of services.
Resources for Human Development is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, age, religion, gender, gender identity, sexual orientation, national origin, genetic information, veteran, or disability status.
What We Offer You:
- Commitment to maintaining a values-based and trauma-informed environment for all
- Scholarship program and tuition discounts at local and online colleges and universities
- Comprehensive health care coverage including medical, eye, and dental for qualifying staff
- Retirement savings plan
- Generous paid time off
- On-the-job training
What You’ll Love About RHD:
- Commitment to Values: We are committed to the fundamental value of dignity and respect for all human beings, to the empowerment of our consumers and staff, and to the flexibility to meet the changing needs of all our partners and those we serve
- Dedication to Wellness: We value and prioritize our employees’ mental, physical, and emotional health by providing free, online fitness classes, nutrition services, counseling
- sessions, and webinars on various health-related topics
- Investment in Growth: We offer programs and workshops to our staff that support furthering education and the development of leadership skills
This can be an opportunity to work remotely.
Responsibilities/Duties:
Leadership and Staff Management
- Provides direct supervision and direction to the Compliance Regulatory Coordinator
- Provides staff oversight to Compliance Regulatory Managers regarding investigations and suspicions of improper billing
- Provides staff oversight regarding program reviews/audits to determine compliance with contracts and provider agreements, including random prospective audits prior to submission of billing
Administrative Oversight
- Collaborate in the design and development of the annual Compliance Work Plan
- Ensure timely communication and responsiveness to issues, tracking to resolution
- Identify and track risks and negative trends on non-compliance and fraud, waste, and abuse activities : propose or implement necessary recommendations or remedial actions
Compliance
- RHD is a responsible “steward of public trust” and the Senior Compliance & Regulatory Manager will supervise and support best practices to promote ethical conduct in general and to prevent fraud, waste, and abuse of federal and state funds
- Provide consultation to programs related to Federal and State laws, funder contracts/provider agreements, RHD Compliance Policies, systems for program level audits, and the development and implementation of corrective action plans
- Provides Specialized training on compliance, HIPAA, and related topics to departments and programs as needed to ensure compliance with RHD Training and Education Policies. Assists with development of compliance training materials and resources
Analytics
- Cross-reference and analyze data sets
- Analyze data sets for investigations and compliance audits
- Cleans and normalizes data
Financial Management & Other
- Assist with oversight regarding overpayments to appropriate payor
- Assist with oversight and adhering to the legal requirement that overpayment is reported and returned to the appropriate payor within 60 days after the date on which the overpayment was identified
- Communicate to internal staff such as Director of Finance & Operations, and other relevant staff throughout the overpayment process
Required Experience
- Seven years’ experience in human service delivery and/or compliance management.
- Experience with managed care, private, state, or federal contracts; knowledge of regulations/laws related to Medicaid/Medicare billing.
Required Education
- Advanced degree and/or certification in Healthcare Compliance (CHC), or investigatory certification preferred. BA or BS Degree with significant relevant experience may substitute for an advanced degree.
Required Qualifications
- Ability to work independently with minimal, direct oversight and to take direction when needed.
- Investigative skills, including ability to formulate investigative questions and methods, structure related interviews, review documents and collect evidence, and objectively determine findings and make relevant recommendations.
- Auditing skills, including the ability to determine an appropriate audit sample, develop audit tools to meet the purpose of the audit, and read clinical, personnel, and billing records to determine compliance with laws and regulations.
- Familiarity with RAT-STATS preferred
- Interpersonal style characterized by professionalism, patience, effective communication skills, and ability to remain calm in emotionally charged situations. Excellent relationship building skills.
- Ability to coordinate work within a team environment.
- Advanced knowledge of Microsoft Excel and Word
- Excellent writing and computer skills; skills in public speaking and presentations.
- Ability to travel to RHD program sites regionally and nationally, as needed.
Program Summary:
RHD Compliance program utilizes best practices to promote ethical conduct and to prevent fraud, waste, and abuse of federal and state funds.
RHD employees and programs in the City of Philadelphia are required to follow the COVID vaccine mandate. The City of Philadelphia has issued an Emergency Regulation Governing the Control and Prevention of COVID-19 Mandating Vaccines for Healthcare Workers and In Higher Education, Healthcare, and Related Settings (“Vaccine Mandate Regulation”), which mandates vaccines for healthcare workers and in higher education, healthcare, and related settings. This mandate became Effective on August 16, 2021, and requires Healthcare Workers and certain workers at Healthcare Institutions to be fully vaccinated by October 15, 2021. Fully vaccinated means it has been two weeks since the final dose of the vaccine. The regulation does allow individuals to apply to RHD for an exemption based on a sincerely held religious belief that would prohibit vaccination for COVID-19 or because of medical conditions that preclude the administration of one of the available vaccines.
About Resources For Human Development, Inc.
RHD is a national, comprehensive human services organization. Our mission is to provide caring, effective, and innovative services that empower people of all abilities as they work to achieve the highest level of independence possible while building better lives for themselves, their families, and their communities. RHD currently supports programs in: Connecticut, Delaware, Florida, Iowa, Louisiana, Massachusetts, Missouri, Nebraska, New Jersey, North Carolina, Pennsylvania, South Dakota & Tennessee!
About Resources For Human Development, Inc.:
RHD is a national, comprehensive human services organization. Our mission is to provide caring, effective, and innovative services that empower people of all abilities as they work to achieve the highest level of independence possible while building better lives for themselves, their families, and their communities. RHD currently supports programs in: Connecticut, Delaware, Florida, Iowa, Louisiana, Massachusetts, Missouri, Nebraska, New Jersey, North Carolina, Pennsylvania, South Dakota & Tennessee!
colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.