Job Summary
JOB SUMMARY
Work to ensure the Company's compliance with contractual requirements and federal, state, and local government regulations pertaining to the Company's health care supplier business (with a focus on durable medical equipment and supplies), including monitoring operational functions, conducting routine audits, and serving as a resource for addressing questions from the business.
Research and keep current on federal, state, and local government regulatory and compliance matters impacting a highly regulated health care business.
Prepare and complete health care regulatory and compliance policies and guidance documents.
Reports to Chief Compliance Officer.
Job Description MAJOR RESPONSIBILITIES
Along with Chief Compliance Officer, provide day to day guidance to business on strategies and initiatives.
Conduct and oversee regular and routine auditing and monitoring of functions pertaining to the compliant operation of a durable medical equipment supply business, with a focus on activities that are deemed to be higher risk in accordance with federal, state and local laws and regulations.
Conduct regular and routine auditing and monitoring of claims submission, billing and payment functions for compliance with applicable payer rules and Medicare/Medicaid requirements.
Prepare and provide reports and analysis to the Compliance Officer and Company executive management detailing audit results, rule violations, the status of investigations, corrective or preventive actions underway and any recommendations for compliance program improvements.
Report matters involving compliance with law or regulation to the Legal Department.
Oversee updates, revisions and releases of company policy and guidance documentation and ensure current revisions are available for employees to access and review and consistent with risk areas identified through auditing and monitoring.
Assist with roll out and implementation of company polices and guidelines based on identified risk areas and changes in policy or regulation.
Research and track federal, state, and local government regulatory and compliance matters impacting a highly regulated health care business to ensure that Company policies and guidance are current and that ongoing audits are consistent with legal and regulatory changes.
Keep abreast of industry standards and outlooks related to corporate responsibility and compliance practices, as well as regulatory news that could affect the company's business activities regionally, nationally or internationally.
Update policies and guidance documents as needed to address changes to laws, regulations, or company rules and guidelines.
Manage and control records relating to audit results, reports of noncompliance, and investigation requests and results.
Evaluate records and the compliance program's documented policies and procedures.
Plan and perform process and documentation audits to ensure written policies meet company needs and regulatory requirements and validate employee awareness of the company's rules and expectations.
Facilitate communications to, and training for, new employees and for existing employees when new rules are established, revisions are made to existing policies and as periodic reminders of employee responsibilities to following compliant work practices.
Serve as a resource on compliance matters for business colleagues.
Assist with the development and roll-out of training on the company's compliance policies and guidance.
May train new employees during orientation and the entire employee population as needed to address changes to company requirements and expectations.
- Management responsibilities include:
Typically manages through multiple Managers
Provide leadership and management to one or more major departments of an operating unit or to a department that has system-wide accountability - Strategic, tactical and operational planning (12 + months) for the function or department
Direct budgetary responsibility for one or more departments, functions or major projects/programs
Interpret and execute policies for departments/projects; develop, recommend and implement new policies or modifications to existing policies
Hiring staff, recommending pay increases, performing performance reviews, training and development of staff, estimating personnel needs, assigning work, meeting completion dates, interpreting and ensuring consistent application of organizational policies
MINIMUM QUALIFICATIONS Education
Bachelor's degree.
Graduate degree preferred.
Certification / Licensure
None required.
Work Experience
At least 7-10 years compliance, regulatory or auditing experience.
Familiarity with coding and reimbursement.
Knowledge / Skills / Abilities
Experience with standard concepts, practices, and procedures within the medical field, with preference for familiarity with Medicare Part B.
Advanced level skill in Microsoft Excel (for example: using AVERAGE function, merging and centering cells, printing centered page and/or creating a pivot table).
Attention to detail and clear communication.
Ability to work with people and participate regularly in on-site activities and projects.
Experience directly managing people including hiring, developing, motivating, and directing people as they work.
PREFERRED JOB REQUIREMENTS
Advanced degrees or coursework in law, compliance, healthcare finance, or business.
Experience working with SAP, SharePoint and/or data analysis tools.
Benefits - Medline is committed to offering competitive benefits and a variety of choices to best meet the needs of you and your family.
For employees scheduled to work at least 30 hours per week, this includes health and well-being, financial fitness, career development, paid time off and more.
Employees scheduled to work less than 30 hours per week can participate in the 401(k) plan, access the Employee Assistance Program (EAP), Employee Resource Groups (ERG) and Medline Service Corps.
For a more comprehensive list of our benefits, please click here.
Every day, we're focused on building a more diverse and inclusive company, one that recognizes, values and respects the differences we all bring to the workplace.
From doing what's right to delivering business results, together, we're better.
Explore our Diversity, Equity and Inclusion page here.
Medline Industries, LP is an equal opportunity employer.
Medline evaluates qualified applicants without regard to race, color, religion, gender, national origin, age, sexual orientation, gender identity or expression, protected veteran status, disability/handicap status or any other legally protected characteristic.