Director of Compliance Gilchrist

Greater Baltimore Medical Center (GBMC)
United States, Maryland, Hunt Valley
Jan 10, 2025
In conjunction with the GBMC HealthCare System's (GBMC) Corporate Compliance Program, responsible for ensuring the regulatory compliance for Gilchrist, with limited supervision by the Gilchrist Section Chief for Hospice and GBMC Compliance Officer. Participates in the annual and on-going risk assessment process of identifying and assessing areas of documentation compliance risk for the hospice and palliative care programs, performs compliance reviews of Gilchrist activity as directed by the Governance Committee annually. Reviews, evaluates, and recommends to management procedures, processes and controls to enhance the control environment and compliance with regulations. Ensures Hospice records/systems are maintained in compliance with all accreditation and governmental regulatory agencies' standards. Designs systems and improves information retrieval methods to make data more accessible. Education: Bachelor's degree in nursing required Advance degree and/or certification (e.g., MBA, MSN, or JD): multiple educational backgrounds are appropriate, such as health, legal, clinical, etc preferred. Experience: 7-10 yrs of experience in hospice and palliative care. with related healthcare compliance experience Skills * Knowledge of business and management controls; general review and audit processes. * Knowledge of Medicare billing and third-party payer coding and billing regulations. * Skill in oral and written communication * Skill in using computers and personal productivity applications * Skill in financial and data analysis * Skill in public speaking and presenting to groups * Ability to identify routine and complex audit-related problems. * Experience managing multiple office locations. * Strong leadership and communication skills * Advanced knowledge in leading organization-wide initiatives * Ability to understand and articulate complex regulatory information Licensures Certifications * Complete Hospice Regulatory Bootcamp within one year * PI Master within one year Physical Requirements * Ability to sit, stand, walk, concentrate, and pay close attention to detail Working Conditions * Works in normal office environment where there are no physical discomforts due to dust, dirt, noise, and the like. Regular travel between office and main hospital campus. Patient & Workplace Safety Employee has knowledge and understanding of patient and workforce safety as it relates to job duties. Patient Population Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable. Principle Duties and Responsibilities Manages the entire Compliance Program for Gilchrist , which falls under the Compliance Program for the GBMC health system. Monitors audit related resources and websites (if applicable) to ensure that up-to-date audit mitigation strategies are in place for Gilchrist Develops and maintains policies and procedures for compliance-related activities to ensure consistency and compliance among the various staff and teams. Primary focus is on initial and ongoing eligibility for services with clear supportive documentation. Assists with , coding, billing and reimbursement areas as needed Monitors responses to inquiries regarding audits s including the full process of appeals and reports findings and trends for service line and senior leaders. Recommends development of new policies and procedures, as a result of pre-billing reviews, audit findings, documentation and subsequent investigations. Develops and implements educational programs for the Gilchrist divisions and service areas as needed to respond to regulatory initiatives and identified deficiencies. Prepares and submits reports on the results of pre-bill and audit findings , recommending improvements in policies and procedures, staff development and educations and modifications to mistake proof the EMR. Develops and communicates corrective action plans, following up as needed with leaders With guidance from GBMC's Compliance Officer, supports the leaders with the investigation of any issues of non-compliance and implements appropriate corrective regulatory procedures in a thorough and accurate manner. Develops quarterly written reports on Compliance activities to GBMC's Audit and Compliance Committee of the Board. Maintain working knowledge of CMS conditions of participation and Medicare billing requirement. Participates in all NPHI regulatory sessions with President. Reviews the annual OIG, MedPac reports and PEPPER reports which along with pre-billing and audit findings is used to create an annual compliance plan, which is incorporated into the GBMC health system's annual compliance plan. The annual plan is subject to approval by GBMC's Audit and Compliance Committee of the Board and the plan's progress is reported to the Gilchrist Governance Committee monthly. Ensures information retained and disseminated is handled in accordance with Gilchrist policies as well as according to standards established by outside agencies (ex: CHAP,CMS, Medicaid, & HIPAA). Attends GBMC's Compliance and Risk Management Committee. Receives reports of suspected HIPAA violations from Gilchrist staff, physicians, or patients and elevates to GBMC's Compliance Officer All roles must demonstrate GBMC Values: Respect I will treat everyone with courtesy. I will foster a healing environment. Treats others with fairness, kindness, and respect for personal dignity and privacy Listens and responds appropriately to others' needs, feelings, and capabilities Excellence I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others. Meets and/or exceeds customer expectations Actively pursues learning and self-development Pays attention to detail; follows through Accountability I will be professional in the way I act, look and speak. I will take ownership to solve problems. Sets a positive, professional example for others Takes ownership of problems and does what is needed to solve them Appropriately plans and utilizes required resources for various job duties Reports to work regularly and on time Teamwork I will be engaged and collaborative. I will keep people informed. Works cooperatively and collaboratively with others for the success of the team Addresses and resolves conflict in a positive way Seeks out the ideas of others to reach the best solutions Acknowledges and celebrates the contribution of others Ethical Behavior I will always act with honesty and integrity. I will protect the patient. Demonstrates honesty, integrity and good judgment Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers Results I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals. Embraces change and improvement in the work environment Continuously seeks to improve the quality of products/services Displays flexibility in dealing with new situations or obstacles Achieves results on time by focusing on priorities and manages time efficiently Pay Range Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs. COVID-19 Vaccination All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners. Equal Employment Opportunity GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.