PURPOSE OF POSITION:
The Compliance Officer has primary responsibility for promoting and directing Integrated Health Collaborative’s compliance with Federal, state and local laws, rules and regulations affecting the Medicare Shared Savings Program. The position is responsible for the day-to-day operation and oversight of the Integrated Health Collaborative compliance program.
Primary Responsibilities:
- Direct and coordinate Integrated Health Collaborative’s efforts to ensure compliance with laws, regulations, CMS guidance and the Organization’s policies that govern its Medicare Shared Savings Program (MSSP).
- Serves as principal contact with government agencies on MSSP compliance matters.
- Develop and maintain compliance policies and procedures for the general operation of the MSSP Compliance Program and related activities to help prevent illegal, unethical or improper conduct. Additionally, review all policies and procedures that are relevant to compliance to ensure consistency throughout the organization.
- Report to the Executive Compliance Committee at least quarterly to report on compliance and to obtain guidance and feedback from the Committee.
- Report to the Board of Directors on at least a quarterly basis, or more frequently as necessary, on the status of MSSP Compliance Program, the identification and resolution of potential or actual instances of noncompliance, and IHC’s oversight and audit activities.
- Creating and coordinating, or appropriately delegating, educational training programs to ensure that IHC’s officers, directors, managers, employees, participants and other individuals are educated on the MSSP Compliance Program; the standards of conduct, policies, and procedures; and applicable statutory, regulatory, CMS guidance and other requirements. Briefing the compliance committee and governing body on the status of general and specific training.
- Promptly respond to questions, issues and reports involving potential compliance issues. Investigate any issues of suspected non-compliance and ensure that appropriate corrective action(s) are implemented.
- Coordinating personnel issues with Human Resources and others to ensure that the DHHS OIG and GSA exclusion lists have been checked with respect to all employees, officers, directors and managers as well as participants are not included on such lists.
- Ensure that internal compliance monitoring and audits are conducted, including annual or periodic reviews of the various functional areas.
- Develop corrective action plans to address non-compliance in the various departments, and ensure that corrective actions are documented and completed.
- Consults with appropriate executives on compliance issues that impact the ongoing operation of IHC
- Report misconduct to CMS, its designee and/or law enforcement in a timely manner as described in the IHC policy.
- Manages the department budget. Controls expenses while meeting operational, financial, and service requirements.
- Develops and motivates staff members. Initiates and communicates a variety of personnel actions including performance reviews and disciplinary actions.
- Performs other duties as assigned.
Job Qualifications:
Bachelor’s degree and seven plus (7+) years related experience. Previous state or federal regulatory or managed care or MSSP compliance experience preferred. Previous management experience preferred.
- High integrity.
- Excellent organizational and analytical skills. Ability to work well both independently and with others in a matrix environment.
- Excellent judgment.
- Strong influencing skills and perseverance in investigating.
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, governmental regulations, and legal documents.
- Excellent oral and written communication skills. Ability to write clear, concise reports, business correspondence, and procedures.
- Ability to effectively present and represent the plan’s interests externally with regulators.
- Ability to effectively present information and respond to inquiries from employees, regulatory agencies, and other, as necessary.
- Ability to initiate administrative activities as necessary, and institute quality control procedures.
- Ability to meet aggressive deadlines and adjust to changes in company policies, procedures, and priorities.
- Proficient computer skills, including MS Word, Excel and Internet searching skills.
PHYSICAL REQUIREMENTS:
90%v sitting, 10% standing and walking.
Lifting, sometimes up to 20 lbs.
Some bending, twisting, pushing, pulling, reaching over the head, kneeling and climbing stairs.
HAZARDOUS EXPOSURE CATEGORY:
Category III—tasks that involve no exposure to blood, body fluids, or tissues.
PI271463901
