Duties and Responsibilities:
- Overseeing, monitoring the compliance program.
- Updating the Compliance Plan in response to requirements set forth in laws, regulations, government entities, and payers as well as to changes within the industry and the organization.
- Reporting on a regular basis to the governing body, CEO, and the Staff Compliance Committee in order to present and discuss potential areas of risk, methods to improve the organization’s quality of service and reduce vulnerability to fraud, waste, and abuse.
- Responding to government inquiries, audits and requests.
- Ensuring that excluded individuals and entities are not employed or retained by the organization.
- Directing Agency internal audits established to monitor effectiveness of compliance standards.
- Independently investigating and acting on matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and any resulting corrective action with all departments, providers, and sub-providers, agents and, if appropriate, independent contractors.
- Providing guidance to management, medical/clinical program personnel, and individual departments regarding policies and procedures and governmental laws, rules, and regulations.
- Overseeing the agency’s risk assessment process and monitoring progress on identified objectives.
- Maintaining a reporting system and responding to concerns, complaints, and questions related to the Compliance Plan.
- Ensuring that independent contractors (patient care, vendors, billing services, etc.) are aware of the requirements of the Agency’s Compliance Plan.
- Acting as a resource regarding regulatory compliance issues. Actively seeking up-to-date material and releases regarding regulatory compliance.
- Serving as HIPAA Privacy Officer and coordinating privacy program, including implementing policies and procedures, coordinating educational programs training and advising on use and disclosure of PHI.
- Resolving issues related to information breaches, developing corrective action, and monitoring developments in privacy rules.
- Establishing working relationships with government oversight entities and members of trade associations.
- Master’s level or equivalent preferred.
- 10+ years of related experience required.
- Excellent written and verbal communication skills.
- Strong commitment and passion for the organization’s mission.
- Unquestionable ethics and integrity.
- Demonstrated knowledge of federal, local, and state regulations and their applications to non-profit organizations.
- Strong commitment toward diversity and inclusion; values diversity of background, thought, and perspectives.
- Experience abiding by rules of compliance, specifically in areas with legislative oversight bodies such as OPWDD, MSC, NYOMH and DOH.
- Proven aptitude for conducting internal audits.
- Ability to Identify and respond to sensitive program and organizational issues, concerns and needs.
- Work successfully with other senior leadership in a collaborative environment.
- Open minded with excellent interpersonal and active listening skills.
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