Purpose:
Under the direction of the Chief Compliance Officer, this position will be responsible for coordinating comments to proposed changes in billing and reimbursement regulations with experts from operations, revenue cycle, insurance and compliance. The role will also be responsible for conducting regulatory research and analysis for overarching regulations that affect UPMC. This position will require strong regulatory and interpretation experience coupled with support of an efficient comment and review process. The position ensures management and employees are in compliance with the rules and regulations of all regulatory bodies, company policies and procedures, and also ensures behavior in the organization meets the company’s Code of Conduct. This position will be the key liaison to determine priorities together with the health services division, including the physician services division and the office of Ethics and Compliance. The incumbent must possess strong interpersonal leadership and presentation skills and be proficient in collaboration, conflict resolution, group interaction and dynamics, project management and facilitation of large-scale organizational transformation. This individual must have the ability to handle multiple tasks simultaneously and be detailed oriented yet able to see and address the big picture.

Responsibilities:
 

• Coordinate and facilitate the work of Expert Groups to help assure UPMC is aware of changes in CMS regulations, comments to CMS on proposed changes as appropriate and develops plans to implement final regulations in a timely manner.
• Assist in developing and managing compliance programs to achieve compliance with regulations, rules and standards or conduct.
• Assist in establishing policies and procedures to support compliance work plans, develop and conduct educational and training sessions related to specific compliance topics.
• Lead a team of professionals responsible for regulatory response, education and training.
• Develop and lead training and education efforts, as needed.
• Build upon and drive consistency of objectives, processes and tools. 
• Identify and appropriately escalate any pertinent issues to senior management as needed.
• Work collaboratively with other leaders throughout the hospital division business unit to establish regulatory and education initiative goals and objectives.
• Keep current with changing industry standards and requirements, including all relevant laws, rules and industry standards and company practices.
• Coordinate and manage UPMC’s response to various Compliance related inquiries filed by the OAG and other healthcare regulatory agencies.
• Direct activities in collaboration with Office of Ethics and Compliance to standardization of compliance practices.
• Maintain current industry knowledge and trends, attending educational events, acquiring certification, and participating in committee work is appropriate.
• Keep abreast of all healthcare changes as well as third-party regulations and ensure updates to systems, policies and procedures are implemented.
• Problem solve in relation to managing different aspects of the revenue cycle, and investigation of billing issues.
• Perform other duties as identified.