Healthcare Compliance Manager/Privacy Officer
The Healthcare Compliance Manager/Privacy Officer will develop and oversee the Adelante Healthcare Inc. corporate compliance program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. Oversees corporate compliance plans and activities, promotes staff and organizational compliance and risk management through ongoing education. The position informs the Board of Directors, management and employees of regulations and ensures organization is operating in compliance with all federal and state requirements that the necessary company policies and procedures are in place.
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 to 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:
- BA or BS, preferably in Business, Finance or healthcare related field
- Technology savvy, especially Microsoft products, Excel, Powerpoint, Word, as well as SharePoint, and experience with an Electronic Medical Record (EHR)
- Certified in Healthcare Compliance required or attained within first year of employment, and at least one of the following: Certified Professional Coder (CPC/CPC-H), Certified Coding Specialist (CCS) or Registered Health Information Technician (RHIT) or Privacy/HIPAA Certification
- Three to five (5) years' experience in healthcare preferred, including significant experience in health care compliance
- Knowledge of HRSA, FTCA, and TJC 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.
- Excellent analytical, organizational and interpersonal skills
- Valid Level One Fingerprint Clearance Card issued by the Arizona Department of Public Safety for all specialty behavioral health locations
- Focus on ensuring all Policies & Procedures are current and follow process for posting for all employees access
- Ensuring that AHC conducts its activities in compliance with all federal, state and local laws and regulations and in conformance with the highest standards of business integrity
- Designing, implementing and maintaining AHCs compliance program to help all employees, management, and board members achieve these objectives by establishing general overall framework for conducting our activities with integrity and accountability pursuant to a shared set of ethical and legal principles
- Monitoring AHC is compliant with all of its contracts and agreements including but not limited to CMS; CMS Medicare Shared Savings Program; risk contracts, Commercial payer arrangements; Employer; Vendor and Consulting contracts
- Collaborating with partner organizations regarding local policies that support compliance activities
- Overseeing all day-to-day aspects of the compliance program
- Review the handling of Subpoenas that requires Custodian or records signature and release
- Develops and maintains a compliance auditing/monitoring plan for the organization based on an objective organizational risk assessment. Identifies potential areas of compliance vulnerability and risk
- Develops action plans on all identified risks and monitors the progress
- Partners with People Services for annual renewal and education of Code of Conduct for all staff
- Directs appropriate department to facilitate corrective actions plans for issues to be resolved and monitor changes have been resolved
- Documents all corrective action and reports these findings quarterly to the Compliance Committee of the Board
- Oversees development, implementation, maintenance, posting and adherence of and to the organizations policies and procedures in compliance with federal and state laws and regulations as well as ethical standards, including any related to privacy and information security
- Promote and maintain a culture of open communication, compliance and responsible behavior meeting the Adelante Healthcare Code of conduct
- Develop, publicize and maintain a reporting/tracking system whereby employees can report compliance issues and concerns without fear of retaliation
- Respond to incidents and requests for review of cases identified by staff, patients or third parties. Facilitate the investigation and resolution of any issues identified
- Review all results and compliance from audit requests from all external entities, including CMS, HRSA, Commercial payers, etc.
- Assist management and legal counsel with contract development to assure compliance with applicable licensure requirements, laws and regulations
- Work with People Services to monitor enforcement of compliance expectations through appropriate disciplinary action
- Working with People Services personnel to ensure proper background checks are performed when required including exclusion lists
- 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
- Maintains a strong awareness of existing laws and regulations affecting AHC while keeping abreast of current changes. Informs the employee population regarding these compliance matters through personal initiatives, seminars, training programs, peer contact, and other education efforts
- Serve as the AHC Corporate Privacy Officer
- Provide training and education to new and existing staff on HIPAA, PHI and other compliance related items.
- Identifies issues that require input from and/or approval of Legal Services and referring these issues for legal review and resolution. Assists Legal Services in analyzing AHC related legal and compliance issues
- Collaborates with departments and clinical areas to identify statutory and regulatory requirements and organizational policies, and notify appropriate department to facilitate the implementation of remedial measures when necessary and monitor changes have been implemented
- Supports the submission of annual FTCA Deeming process
- Submission and distribution of Annual license for each site through Arizona Department of Health Services
- Audits site required items for all health centers
- Responding to department requests and inquiries on all legal and compliance questions
- Facilitates the HRSA OSV process
NONESSENTIAL SKILLS AND EXPERIENCE:
- Three (3) years of experience in a non-profit community health center
Additional Duties and Responsibilities:
- Other duties as requested or assigned
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.