The Compliance Officer oversees and monitors all aspects of the Corporate Compliance Program within the agency, and functions independently to ensure the agency is in compliance with all regulatory requirements and industry standards, and that agency policy and procedure is being followed
Reports to the Executive Director and Board of Directors no less than quarterly on Compliance activities
Reviews and evaluates the effectiveness of the Compliance Program no less than annually
At least annually develops, implements, and updates a compliance work plan that outlines the agency’s strategy for meeting the requirements of the Compliance Program.
Monitors regulatory developments and any changes in laws, regulations, and industry practices that affect the organization’s operations, and ensures timely updates to compliance policies and procedures.
Drafts and implements the compliance program policies, procedures, and Standards of Conduct to promptly incorporate changes in Federal and State laws and regulations.
Reviews all Compliance policy and procedures, and the Standards of Conduct no less than annually, and updates them as needed.
Coordinates the Compliance Committee meetings with its members, reports to the Committee any changes in federal and state law and regulations, and any updates to policy. Retains meeting minutes as required.
Responds to reports of fraud, waste, and abuse of Medicaid dollars, violations of the agency Standards of Conduct, and other violations of the law. Investigates any reports of fraud, waste, and abusive practices within the agency and develops a plan of corrective action.
Develops and conducts internal audits of compliance risk areas, performs regular billing audits and QA reviews to identify any issues or gaps, and develops corrective action plans as necessary.
Monitors and oversees the Compliance violations reporting process, including the compliance hot line.

QUALIFICATIONS
Education: A Bachelor’s degree in Law, Healthcare Administration, Business Administration, Social Work or other relevant field is required; Master’s Degree in similar field or a professional license (RN, LCSW, LMHC) and professional certification in compliance or a relevant discipline is preferred (CPCO, CHC, RHIA)
Experience: A minimum of 10 years’ experience in a healthcare organization, to include demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must.