Working under the direction of the Compliance & Privacy Officer adheres w/ KP Compliance Framework, fosters comprehensive compliance projects through a series of activities to comply w/ all applicable regulations & statutes. Provides professional/technical guidance to team member & employees at large & presents complex information throughout the organization. Impacts the achievement of key functional &/or KP objectives that have direct & significant business impact. Contributes to the development of the department's objectives & annual risk assessments, work & audit plans. Could have a primary functional area of emphasis in one or more of these areas: Investigations, Scope of Practice, Privacy, Health Information Mgmt/Coding, Revenue Cycle, External or Internal Auditing or Statistical Analysis.
Essential Functions:
- Project Planning: Oversees &/or directs teams in identifying accountabilities for local/regional compliance programs & consulting staff
- Oversees the development & completion of annual risk assessments
- Establishes compliance goals, timelines, approaches & strategies in support of organizational initiatives
- Identifies areas of performance improvement & establishes/delegates resources to lead compliance-related projects
- Oversees & leads on-going efforts to establish, identify & manage internal/external resources & agency relationships
- Investigations: Oversees the administration of investigation processes & activities
- Establishes & promotes a collaborative environment w/ other functional areas in investigating potential compliance issues
- As needed for sensitive or political situations, will participate & assist w/ investigation interviews, findings & recommendations
- Collaborates w/ clients to determine complex corrective action plans
- Validation: Manages & leads audits on scope of practice, licensing, site of service & other identified areas at risk for compliance violations
- Oversees the administration of compliance programs & content, including design, completion of risk assessments &/or audits, investigations processes & activities, instances of reported non-compliance
- Assesses completion rates & operational sustainability
- Determines impacts of implementation of new regulations & statutes & required notifications, changes, & training
- May engage external regulatory & legislative bodies on developing regulations & laws
- Implementation: Identifies & implements OIG compliance requirements
- Performs on-going assessment of established solutions to existing alternatives & makes recommendations as needed to implement changes
- Leads & participates in the creation, revisions & development of compliance standards, policies & procedures
- Leads the monitoring of compliance adherence
- Directs reporting on compliance efforts & programs to all levels of the organization
- Influences mgmt & staff to ensure compliance & reporting
- Oversees the development &/or delivery of compliance & ethics training
- Program Mgmt: Facilitates communications, manages relationships w/ stakeholders, & negotiates agreement from involved parties for compliance initiatives & programs across service areas
- Responsible for issue mgmt, response, & mitigation across service areas
- Anticipates issues through regular communication w/ reporting positions & other internal & external parties, mitigating risk or escalating issues for resolution by more senior levels as necessary
- Responsible for leading change mgmt efforts in service areas as well as larger dept'l goals or objectives
- Identifies & acts upon opportunities to leverage and engage direct reporting team in change mgmt activities
- Perform other duties as assigned
Qualifications:
Basic Qualifications:
- Eight (8) - Twelve (12) years of progressive experience in a Health Care Environment, (managerial or clinical disciplines) with at least five years in healthcare compliance and privacy
- Focused experience in any of the following areas: Revenue Cycle, Clinical Documentation/Coding, Risk Management, Auditing/Claims Review, Project Management, Defense Auditing preferred
- Master's degree or equivalent experience in Health Care Administration, Business Administration, Finance, Economics, Operations Research, Public Health or other Health Care related field
- Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred
- If applicant does not have the CHC, then must complete within 12 calendar months of hire
- Advanced knowledge of compliance principles, theories, and concepts
- Extensive knowledge of health care compliance policies, programs, practices, systems, related compliance issues
- Thorough knowledge of the elements of an effective Ethics and Compliance program and broad knowledge of health care industry practices and standards including both federal, state regulations and accreditation standards
- Excellent Skills in written and verbal communication, meeting facilitation, presentations, analysis, collaboration, project management, decision making, stewardship, negotiation, and leadership
- Strong knowledge of federal and state reimbursement program requirements (e.g. Medicare and Medi-Cal) and privacy and consent laws
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.