This position assists the VP and Compliance Director of the Office of Business Integrity to direct and oversee the Phoenix Children`s Hospital (“PCH”) Compliance Program. The Manager will: Execute and assist in leading the Compliance Program as directed by the Compliance Director and Chief Compliance Officer by ensuring the development, implementation, and ongoing monitoring of the Compliance and HIPAA Privacy Program with an emphasis on AHCCCS billing compliance, compliance and privacy related auditing, and training and education for PCH. Critical to the success of this role, the Compliance Manager is responsible for independently assessing a variety of complex compliance and privacy risk-areas to develop the Compliance Department’s work plan. Responsible for independently performing scheduled audits, investigations, and for the content and performance of the HIPAA Privacy Program and corresponding documents and polices on an ongoing basis and takes appropriate steps to improve their structure, performance and effectiveness consistent with industry standards. Works collectively with hospital management and other personnel to ensure the Corporate Compliance and Privacy Program initiatives are implemented across PCH.

1. Monitors the performance of the compliance, and revenue integrity programs and related activates on a continuing basis, taking appropriate steps to improve its effectiveness. Prepares regular reports, as requested by the VP and Director of Compliance and Privacy, detailing compliance initiatives, accomplishments, trends, statistical data, etc. Recommends improvements/changes in the overall compliance program.
2. Develops, oversees, and maintains auditing and monitoring program of system-wide high-risk areas in compliance, privacy, and billing processes. Researches and develops system-wide benchmarks and assures the communication of review findings and alignment of best practices, as relevant, throughout the system. Develops corrective action plans to ensure resolution of risk areas.
3. Oversees compliance strategic planning and risk assessment activities, including the analysis and interpretation of the OIG Work plan, assists in the development of a system-wide annual compliance work plan and the annual audit work plan, and assistance to the operating units in developing departmental work plans.
4. Manages specific risk assessments related to HIPAA and privacy compliance. Assists in privacy monitoring program and ensures ongoing monitoring of inappropriate/unauthorized access and disclosures through use of electronic record monitoring application features and data loss prevention applications in accordance with HIPAA Privacy Rules. Performs trend analysis and prepares summary reports on privacy monitoring activities
5. Develops audit work plans and conducts or supervises both planned and specialized audits of privacy related matters, patient medical records and bills to determine whether charges being billed are adequately supported by documentation in the record and that documented services are being billed and reported, including identification of potential system-wide areas of compliance vulnerability and risk, and development of corrective action plans.
6. Collaborates with other departments, including, but not limited to, Human Resources, Quality, Research, Information Systems, and others, for system-wide integration of compliance programs.
7. Effectively directs outside vendors in completing audits assigned and approved with the Audit Plan.
8. Prepares and assists conducting compliance and privacy education for any applicable areas for which compliance education efforts have been identified. Ensures all confidential and proprietary information and activities are handled discretely and information is safeguarded.
9. Reviews threshold communications from federal, state, or local agencies or from private payors regarding the payment process or the conduct of business, in collaboration and as applicable with the PCH Legal Department. Assists the operating units in responding to such inquires and investigations.
10. Performs miscellaneous job related duties as requested.

To advance hope, healing and the best healthcare for children and their families

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable