Corporate Compliance Officer

Summary:

The Compliance Officer is responsible for overseeing and ensuring that the organization adheres to all applicable federal and state laws, regulations, and internal policies, by developing, implementing and overseeing a comprehensive compliance program that includes the seven elements of an effective compliance program. This includes expected behavior policies, conducting regular audits, ensuring employee training, investigating potential violations, and collaborating with various departments to maintain ethical and legal practices within the organization. The compliance officer is responsible for identifying and assessing areas of compliance risk and collaborating with executive management to effectively incorporate the compliance program within system operations and programs and to carry out the responsibilities of the position.

Key responsibilities:

• Compliance Program Development and Implementation:
  • Create and maintain a compliance program that addresses the seven elements of a comprehensive compliance program. This includes:
  • Clear and documented guidelines outlining expected behavior and compliance standards across the organization.
  • Designated individuals with responsibility for overseeing the compliance program, including risk assessments, training, and investigations.
  • Regular training sessions for all employees covering relevant compliance regulations, policies, and ethical conduct.
  • Open and accessible communication channels for employees to report potential compliance concerns without fear of retaliation.
  • Regular reviews and assessments to identify potential compliance risks and ensure adherence to policies.
  • Established disciplinary actions for violations of compliance policies, clearly communicated to all employees.
  • A system for timely investigation and corrective action when compliance issues are identified.

• Conduct regular compliance audits to monitor adherence to policies and regulations. Conduct risk assessments to identify potential compliance vulnerabilities within the organization.
• Analyze billing data and medical records to identify potential compliance issues.
• Investigate complaints or suspected violations of compliance policies.
• Report compliance concerns to senior management and the compliance committee (PACE SEMI Board of Trustees).
• Communicate compliance updates and policy changes to relevant staff members.
• Collaborate with legal counsel on complex compliance matters.
• Promote a culture of compliance through open communication and employee engagement.
• Work closely with various departments including clinical operations, health plan management, finance, IT, and legal to address compliance concerns.
• Maintain relationships with regulatory agencies and stay updated on industry compliance trends.
• Established procedures for voluntarily self-reporting fraud or misconduct related to the PACE program to CMS and the State administering agency.

Required Skills and Qualifications:

• Bachelor’s degree in healthcare related field. Masters preferred.
• Strong understanding of PACE & healthcare regulations, including HIPAA, Stark Law, Anti-Kickback Statute, and Medicare/Medicaid guidelines.
• 5 plus years of experience in compliance auditing and risk assessment methodologies.
• Excellent communication and interpersonal skills to effectively train and educate staff.
• Legal and analytical skills to interpret complex regulations and investigate compliance issues.
• Ability to collaborate with diverse stakeholders within and externally.
• Healthcare industry experience, preferably in a clinical or administrative role.

Equal Opportunity Employer
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