Compliance and Training Director
The Compliance and Training Director will oversee the development, design, implementation and evaluation of Adelante Healthcares compliance and training programs which will align with the necessary objectives and strategies of the organization. Identifies training and development requirements by conducting a needs analysis; analyzing organizational results, job requirements, operational problems, plans, and forecasts current training programs. This position is responsible for identifying trends, prioritizing, and providing guidance to Adelante Healthcares management teams.The position informs the Board of Directors, management, and employees of regulations and ensures the organization is operating in compliance with all federal and state laws/requirements.
Every Adelante Leader will strive to maximize the performance and contribution of each team member to Adelante Healthcare and the community that we serve every day. Leaders will set clear performance expectations, provide on-going feedback and coaching to improve results and outcomes and provide regular performance evaluations. Leaders are also expected work in a manner that demonstrates a commitment to quality, patient safety, employee engagement, innovation, and model for all other employees the highest standards of personal integrity, professionalism, and competence.
OUR CORE VALUES
ESSENTIAL SKILLS AND EXPERIENCE
- Masters Degree and 7+ years industry related experience in health care corporate risk and compliance preferred
- CHC (Certified in Healthcare Compliance) and CPHRM (Certified Professional in Health Care Risk Management) required or attained within first year of employment
- Certified Professional in Health Care Risk Management (CPHRM) preferred
- Strong knowledge of healthcare clinical fundamental, patient safety standards and compliance standards
- Knowledge of HRSA and FTCA requirements
- Knowledge of Stark, Anti-Kickback, HIPAA, HITECH, and state privacy laws
- Knowledge of healthcare compliance regulations including HIPAA Privacy, Coding, Billing, Exclusions, Investigations and Corrective Action Plans.
- Experience writing and designing curriculum
- Data analysis and interpretation experience and skills
- Develops effective training materials utilizing a variety of media
- Effective oral and written communication skills
- Excellent interpersonal skills
- Demonstrated ability to engage physicians, other medical professionals and support staff and build consensus
- Commitment to AHC mission, vision, and values
- Competency in dealing with people of various cultures and social status
- Project management backgrounds a plus
- Prior experience must also demonstrate strong leadership skills and the ability to influence, collaborate with and motivate others
- Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety
NONESSENTIAL SKILLS AND EXPERIENCE
- Bilingual English/Spanish Preferred
- Three (3) years of experience in community health
The qualifications listed above are intended to represent the minimum skills and experience levels associated with performing the duties and responsibilities contained in this job description. The qualifications should not be viewed as expressing absolute employment or promotional standards, but as general guidelines that should be considered along with other job-related selection or promotional criteria.
- Oversees a corporate compliance, risk, privacy, and training program, develops, and maintains a written corporate compliance plan and annual evaluation of the plans effectiveness; ensures that all required elements of a compliance program are addressed.
- Facilitates effective AHC Compliance Communication program, including promotion of the (a) use of the hotline, (b) heightened awareness of the organization Code of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
- Disseminating information to and educating of Adelante Healthcares employees regarding a broad spectrum of compliance, risk, and privacy related topics
- Maintaining a current working knowledge of Federal and State regulations and policies as they affect the organization through routine review of various manuals, applicable government and/or industry related internet information sites.
- Will function as a Board Liaison. Functioning as key company representative/liaison in meetings with federal/state agencies, and industry organizations regarding regulatory policy.
- Providing education and training about actual, proposed, or pending legislation and regulations that affect operations and identifying operational obstacles to compliance, and working with other employees to identify and implement solutions.
- Reporting to the Board of Directors on compliance-related matters as appropriate.
- Measures compliance by conducting routine and/or focused internal audits of policy and procedure adherence as well as coordinating audits generated by external sources.
- Development, coordination, and participation in routine multifaceted educational and training programs that focus on the elements of the Compliance, Risk and Privacy Program thus striving to ensure that all appropriate employees and management are knowledgeable of, and comply with, pertinent Federal and State Health care program requirements
- Create course calendars and curriculum by position, facilitate various courses, and modify programs as needed
- Periodically evaluate and report on training effectiveness for the organization
- Exemplify the desired culture and philosophies of the organization
- Work effectively as a team member with other members of management and the People Services staff
- Coordination of follow-up and resolution to Adelante Healthcares reports/inquiries.
- Periodic revision of Corporate Compliance Program considering changes in the organization's needs, and in the statutes, rules, regulations, and requirements of Federal and State health care programs.
- Obtaining and maintaining all appropriate licensure as applicable and coordinating the reconciliation of any issues and/or problems.
- Analyzing government and/or public policy and alerting the corporation to rends and risks.
- Communicating Adelante Healthcares comments/concerns regarding proposed legislation or impending implementation of policies to appropriate legislators, industry organizations, customer base or other entities as applicable.
- Promote and maintain a culture of open communication, compliance and responsible behavior meeting the Adelante Healthcare Code of conduct
- Developing and maintaining Adelante Healthcares image as a key player and ethical voice in related health care issues through participation in industry organizations.
- In consultation with the General Counsel and Chief Compliance Officer, submits mandatory notification of known or suspected corporate compliance violations to the appropriate regulatory agencies.
- Serves as the corporate leader for HRSA readiness and surveys.
- Collaborate with the CEO, CMO, Director of Quality, Risk and Safety, and Employee Experience Director on regulatory processes annually.
- Establish appropriate structures and processes about risk reporting, incident management, and Health and Safety within the organization.
- Develops, implements, and annually reviews the Risk Management Plan for Adelante Healthcare.
- Collaborates with the General Counsel and Chief Compliance Officer, CMO and Director of Quality, Risk, and Safety on managing all claims as they arise.
- Monitoring AHC is compliant with all its contracts and agreements including but not limited to CMS; CMS Medicare Shared Savings Program; risk contracts, Commercial payer arrangements; Employers; Vendor and Consulting contracts.
- Review the handling of Subpoenas that requires Custodian of Records signature and release.
- Develop, publicize, and maintain a reporting/tracking system whereby employees can report safety, privacy and compliance issues and concerns without fear of retaliation
- Review all results and compliance from audit requests from all external entities, including CMS, HRSA, Commercial payers, etc.
- Work with People Services to monitor enforcement of compliance expectations through appropriate disciplinary action
- Work with People Services personnel to ensure proper background checks are performed when required including exclusion lists
- Provide training and education to new and existing staff on HIPAA and PHI
- Responsible for administering and maintaining various compliance technology solutions, including monthly newsletter, Risk Assessment and Incident Management platforms and Auditing/Monitoring.
- Participates in Adelantes Quality and Safety Committee meetings
- Chairs the Compliance Committee, and others, as appropriate
- Services as AHCs Corporate Privacy Officer
Additional Duties and Responsibilities
- Perform other duties as requested and assigned by the General Counsel and Chief Compliance Officer
All employees are responsible for promoting and participating in interdisciplinary communication and collaboration to enhance the delivery of quality across the health care system. Employees should maintain an environment which supports and engages patients and co-workers in a caring team-based model to promote wellness and improve health outcomes.
Adherence to Compliance and Code of Conduct
All employees are required to comply with Adelante Healthcares written standards, including its Compliance Program and Standards of Conduct, policies and procedures and reporting of any conduct that potentially violates Adelantes legal or compliance requirements. Such compliance will be an element considered as part of the regular performance evaluation.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: While performing the duties of this job, the employee may be required to sit for long periods of time, is required to stand, walk, use hands to handle or feel objects, tools, or controls; reach with hands and arms; climb steps/stairs; balance; stoop, kneel, crouch or crawl; talk or hear; smell; manage stress as it relates to essential job functions. The employee must frequently lift and/or move up to 25 pounds without assistance and may occasionally be required to lift or move up to 50 pounds with assistance. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work environment: While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time when traveling to various clinic sites. The noise level in the work environment is usually moderate. The employee may be subject to health hazards (contagious diseases, blood borne pathogens, etc.) when working in the clinic area.
In any organization or job, changes take place over time. Although an effort will be made to keep job-related information current, this is not an all-inclusive list of job responsibilities. Adelante Healthcare, Inc. reserves the right to revise or change job duties and responsibilities as the business need arises. In compliance with EEOC 29 CFR part 1630, if the essential functions of this position cannot be performed in a satisfactory manner by the employee, further accommodations shall be made if it does not constitute undue hardships upon this organization.