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Under the strategic direction of the Vice President and General Counsel, this position is responsible for leading and directing the activities of the department of University healthcare billing and research compliance.
Knowledge of healthcare billing regulations and federal university research laws and regulations
Highly effective written, oral and interpersonal communication skills to address a wide variety of sophisticated audiences
Demonstrates professionalism, discretion and judgment through sound decision-making to obtain solutions through collaborative efforts with a wide-variety of offices and departments throughout Saint Louis University
Superior knowledge of state and federal statutes, laws and regulations, industry standards, trends and/or regulatory requirements in expertise subject area.
Expert analytical and problem solving skills
Experience in conducting investigations
Ability to productively assemble, engage, and lead cross-functional teams and lead projects from start to finish
Demonstrated critical thinking skills and ability to implement strategic policy recommendations
Bachelor’s degree required with at least five years of work-related experience
Master’s degree in business, health administration, or suitable related degree or J.D. with experience in a University medical center and University research setting preferred
Compliance certification preferred
Experience in a leadership role in healthcare billing preferred
Develops University-wide compliance policies related to research, HIPAA privacy rules and healthcare billing; develops and implements compliance and training programs for the University community which focus on the compliance policies and procedures and/or detailed procedures relating to fraud and abuse laws, regulations related to research, Medicare billing rules and regulations, HIPAA, Stark and anti-kickback laws;
Develops and implements audits for risk assessment, implements a range of comprehensive internal reviews of the University’s research and clinical billing operations, including, but not limited to, clinical billing, conflict of interest, time and effort certification, clinical trials and export controls;
Monitors and responds to regulatory issues related to research and billing compliance and makes recommendations to University administration; formulates and establishes audits and ensure adherence to an appropriate audit schedule; provides regular reports on compliance audit results to the Board of Trustees committees;
Develops and implements systems to enable reporting, identifying and correcting internal errors; manages the overall compliance operations and staff of the billing and research compliance departments and other various functions of the respective departments; implements a mechanism for distributing new compliance materials and education; maintains a compliance hotline and/or help line accessible to all personnel to report any concerns in a confidential and non-retaliatory manner, including maintenance of a log of the calls; is responsible for monitoring, evaluating and communication of a highly visible and effective compliance program for academic research and clinical billing for the conduct of strategic risk assessment;
Consults with University administrators regarding compliance activities at the unit level and assists with the design of, and at times, conducts independent internal investigations; confers with legal counsel during investigations and areas of significant risk for the University; directs the implementation of specific compliance policies including the development of appropriate sanctions and corrective actions.
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