As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

 

• This position is responsible for ensuring compliance with state and federal requirements applicable to benefit plans offered by the University of Utah Health Insurance Plans.
• This position is responsible for supporting the health plan’s Compliance program with a particular focus on Qualified Health Plan (QHP) compliance requirements.
• This position has no responsibility for providing patient care.

 

Corporate Overview: University of Utah Health is an integrated academic healthcare system with five hospitals including a level 1 trauma center, eleven community health centers, over 1,600 providers, and a health plan serving over 200,000 members. University of Utah Health is nationally ranked and recognized for our academic research, quality standards and overall patient experience. In addition to our clinical delivery system, we have a School of Medicine, School of Dentistry, College of Nursing, College of Pharmacy, and College of Health providing education and training for over 1,250 providers annually. We have over 2 million patient visits annually and research grants exceeding $350 million. University of Utah Hospitals and Clinics represents our clinical operations for the larger health system.

Essential Functions

Job Specific Responsibilities and Accountabilities

• Performs to required standards for job specific responsibilities and technical competencies.
• Develop and implement policies, procedures, and practices designed to ensure compliance with the Office of Inspector General guidance, ACA program requirements, and other applicable laws and regulations.
• Support organization’s compliance program in accordance with all applicable laws and regulations.
• Monitor the day-to-day compliance activities including implementing a monitoring and auditing plan.
• Work closely with all departments for effective investigation, resolution, reporting, and remediation of compliance issues.
• Develop and conduct compliance risk assessments.
• Minimizes legal and compliance risk by monitoring, analyzing, and communicating current and proposed state and federal legislation, regulation, and sub-regulatory guidance.
• Acts as a subject matter expert, answers questions, provides guidance and oversight for resolution of compliance issues that arise in the business.
• Act as compliance lead for ACA products, including coordination with CMS and state regulators, tracking and/or completing required reporting or document submissions, and facilitating any associated audits.

Talent Management

• Hiring, training, developing, and communicating with staff.

Financial Management

• Responsible for developing, monitoring and achieving budget goals.
• Manages labor and non-labor expenses to budget or flex budget.
• Manages revenue to budget to maximize potential revenue.

EPE/Service

• Responsible for upholding PROMISE standards of direct reports and team members.

Quality

• Responsible to achieve goals for assigned area(s).
• Manages and promotes continuous process improvements in assigned area(s).

Performance Management

• Responsible to provide staff feedback on performance, including on-time appraisals and coaching.
• Responsible to deal with conflicts in a proactive manner and to reach resolution in a timely manner.

Building Relationships

• Forms positive relationships with staff, peers, and senior leadership to support the mission, vision, values, and performance standards of the organization.
• Actively engages staff with updates and news as well as involving staff in decisions and work teams. Provides feedback and recognition when appropriate.

Knowledge / Skills / Abilities

• Ability to perform the functions of the position, as outlined above.

• Demonstrated strong verbal and written communication skills.

• Knowledge of applicable statutes and regulations including Utah insurance requirements, ACA provisions, ERISA, Medicare, False Claims Act, Anti-Kickback Statute and Stark Law.

• Strong understanding of health insurance operations.

• Experience performing regulatory analysis, oversight, and internal audits.

• Experience facilitating external audits.

• Ability to assess complex situations and prioritize projects.

• Excellent interpersonal skills, with ability to build collaborative internal relationships.

• Knowledge of the federal and state insurance regulatory environments.

• Strong analytical and project management skills.

• Self-Motivated, with the ability to work under moderate supervision.

Required

• Bachelor's degree in Health Care Administration, Business Administration, or related area.
• Five years of regulatory compliance, or equivalency.

Preferred

• Master's degree in Health Care Administration, Business Administration, or related area.
• Certification in healthcare compliance or compliance and ethics, such as Certified in Healthcare Compliance (CHC) or Certified Compliance & Ethics Professional (CCEP).
• Experience in HIPAA Privacy compliance.
• Seven years of relevant experience.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position in an office setting that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Carrying, Climbing, Color Determination, Crawling, Far Vision, Lifting, Listening, Manual Dexterity, Near Vision, Pulling and/or Pushing, Reaching, Sitting, Speaking, Standing, Stooping and Crouching, Tasting or Smelling, Walking