ࡱ>  H%bjbj(( 4Jh1gJh1g(pp8N$QLMPOPOPOPOPOPOP$pT&WsPNNNsPPT"""NRMP"NMP""iG0J` H$9PPH$QHW: TWHJWJ`""_sPsP!H$QNNNNWpX : Compliance Program Manager Research BillingJob Code: 443000 FLSA Status: ExemptMgt. Approval: T. LepienDate: Feb 2021Department: Business Integrity-Compliance HospitalHR Approval: J. Middleton Date: Feb 2021JOB SUMMARYThe UW Health Business Integrity Department has separate Divisions based on regulatory need. There are Divisions for Professional Service Compliance, Hospital Compliance, Privacy, Internal Audit, Pharmacy Compliance and Research Billing Compliance. These Divisions are cooperative endeavors between UWHC, UWMF, and UWSMPH that ensures activities are compliant with relevant laws, regulations, best practices, and internal policies. These Divisions also ensures workflows are performed transparently, effectively, and efficiently and are managed to best support and advance UW Healths mission. Under the direct supervision of the UW Health VP Business Integrity, the incumbents will oversee the day to day operations for the Research Billing Compliance Divisions (Divisions). This includes the oversight and management of staff. In addition, it is the expectation that these individuals are responsible for the coordination with representatives from all levels of management and departments within UW Health and SMPH. These individuals will chair and staff oversight committees for these programs that will assist in the advancement of the Divisions missions. This position requires a working knowledge of/ability or regulatory to learn applicable policies and procedures of various UW entities as well as applicable state and federal regulations and guidelines. MAJOR RESPONSIBILITIES Use independent judgement and apply a comprehensive understanding of regulations and policies in administering processes to ensure: Are structured as to comply with CMS, FDA, HRSA, and other governmental regulatory requirements related to research billing compliance Operational departments have developed appropriate workflows to comply with the appropriate regulations Establish and oversee the day to day operations of the Research Billing Compliance Division. In collaboration with the VP Business Integrity establish and execute the Divisions quality, efficiency, and effectiveness metrics and periodically assess workload volume, capacity, and turnaround statistics to determine appropriate staffing levels and skill sets. This would include oversight of staff and direct reports Facilitate budget preparations by assisting with Division cost projections and determinations Providing regular reports to the UW Health Compliance Committee, a subcommittee of the Board of Directors Co-Chairing Workgroups/Taskforces (i.e. Research Billing Compliance Committee) multifunctional teams that include representatives from UW Health, SMPH, Affiliates and Joint Ventures. Including the development of agendas, meeting materials, minutes, and action items. Oversee the Research Billing Compliance Divisions training efforts, spanning all educational formats (e.g., computer based training, classroom, 1:1, written materials, website) and across a diverse audience base (e.g., new employees, new leaders, Revenue Cycle, ), to ensure a workforce that is knowledgeable about and compliant with applicable regulations and policies. Oversee and complete routine surveillance audits (e.g. . Medicare Coverage Analysis, Research Billing Analysis, Clinical Trial Reviews, UW Research and Sponsored Programs contracts, informed consent documents, etc.) Complete analysis of data looking for irregularities and outliers signaling the need for audit or investigation. Oversee and complete Investigations of potential billing irregularities and program adherence. In collaboration with VP of Business Integrity and Office of Corporate Counsel respond to external regulatory agencies Provide consulting services for new subject matter initiatives (e.g. research billing modules, etc.) Serve as the Programs primary liaison to management and governance for issues related to the Research Billing Compliance Division ALL DUTIES AND REQUIREMENTS MUST BE PERFORMED CONSISTENT WITH THE UW HEALTH PERFORMANCE STANDARDS.JOB REQUIREMENTSEducationMinimumGraduate of a Medical Coding Program or Associates degree in healthcare related field. Two (2) years experience will be considered in lieu of education. PreferredBachelors degree in healthcare related field. Work ExperienceMinimum Seven (7) years of research billing related compliance experiencePreferredTen (10) years of research billing related compliance experienceLicenses & CertificationsMinimum PreferredCertified Research Coordinator (CRC), Certified Professional Coder (CPC), and Certified in Healthcare Research Compliance (CHRC)Required Skills, Knowledge, and AbilitiesCMS, FDA, DEA, OPA, HRSA, and other governmental regulatory requirements Working knowledge of medical terminology, medical billing, and billing compliance Ability to work collaboratively with others Strong analytical, communication (written and oral) and complex problem-solving skills Proficient with Excel and Word Ability to communicate effectively with Governance, management, investigators, and staff Demonstrate attention to detail and the ability to identify outliers and issues with workflow creating risk Effective leadership skills, ability to create a positive, trusting, respectful, and supportive work environmentPHYSICAL REQUIREMENTSIndicate the appropriate physical requirements of this job in the course of a shift. Note: reasonable accommodations may be made available for individuals with disabilities to perform the essential functions of this position.Physical Demand LevelOccasional Up to 33% of the timeFrequent 34%-66% of the timeConstant 67%-100% of the timexSedentary: Ability to lift up to 10 pounds maximum and occasionally lifting and/or carrying such articles as dockets, ledgers and small tools. Although a sedentary job is defined as one, which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.Up to 10#NegligibleNegligible Light: Ability to lift up to 20 pounds maximum with frequent lifting and/or carrying of objects weighing up to 10 pounds. Even though the weight lifted may only be a negligible amount, a job is in this category when it requires walking or standing to a significant degree.Up to 20#Up to 10# or requires significant walking or standing, or requires pushing/pulling of arm/leg controlsNegligible or constant push/pull of items of negligible weight Medium: Ability to lift up to 50 pounds maximum with frequent lifting/and or carrying objects weighing up to 25 pounds.20-50#10-25#Negligible-10#Heavy: Ability to lift up to 100 pounds maximum with frequent lifting and/or carrying objects weighing up to 50 pounds.50-100#25-50#10-20#Very Heavy: Ability to lift over 100 pounds with frequent lifting and/or carrying objects weighing over 50 pounds.Over 100#Over 50#Over 20#List any other physical requirements or bona fide occupational qualifications: Note: The purpose of this document is to describe the general nature and level of work performed by personnel so classified; it is not intended to serve as an inclusive list of all responsibilities associated with this position.     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