Compliance/ Privacy Officer

Agency Profile: Spectrum Health & Human Services respectfully partners with adults, children, and families as they recover from behavioral, emotional, mental health and/or substance related disorders by offering individualized and meaningful opportunities of hope, empowerment, and support to achieve self-defined improvements in their quality of life.

Full-time: 227 Thorn Avenue, Orchard Park, NY

JOB DESCRIPTION:

Serves as the Agency Compliance Officer and undertakes the primary responsibility for assuring the Agency adheres to all federal, state and county legal and regulatory standards. Lead risk management across the organization in collaboration with leadership. Involvement in daily operations of the organization’s Privacy Program, development, implementation, and maintenance of policies and procedures, monitoring program compliance, investigation and tracking of incidents and breaches, and ensuring individuals’ rights.

ESSENTIAL FUNCTIONS:

• Assume the primary responsibility for assuring the Agency adheres to all federal, state and county legal and regulatory standards for medically necessary service delivery. Serve as the Agency Compliance Officer.
• Manages a strategic and comprehensive privacy program that defines, develops, maintains, and implements policies and processes that enable consistent, effective privacy practices which minimize risk and ensure the confidentiality of protected health information (PHI), paper and/or electronic, across all media types. Ensures privacy forms, policies, standards, and procedures are up-to-date.
• Assist in establishing effective system of assessing current risk and mitigation measures and forecast future risk management needs for existing and emerging business.
• Works with organization senior management, Security Officer, and QI department to establish governance for the compliance and privacy program.
• Collaborates with the Agency Security Officer to ensure alignment between security and privacy compliance programs including policies, practices, investigations, and acts as a liaison to the information systems department.
• Assure agency credentialing is maintained and updated accurately and effectively.
• Oversees the Medical Records Department to ensure proper procedures are in place to protect the confidentiality of those receiving services.
• Takes a lead role, to ensure the organization has and maintains appropriate privacy and confidentiality consents, authorization forms and information notices and materials reflecting current organization and legal practices and requirements.
• Assure and review systems that are in place to verify that clinical documentation and billing meet the standards of current regulations and state and federal laws.
• Assures all staff is oriented to the compliance and privacy program upon hire and adequately trained in the procedures specific to their job descriptions and assure that all staff receives an updated training annually, or more frequently as needed.
• Assure NYS Office of Medicaid Inspector General and US Office of Inspector General annual work plans are monitored for areas of potential audit and risk.
• Assure notices, alerts, and guidance from OMIG or OIG are incorporated into agency operations and practice.
• Assure the Corporate Compliance Plan meets state and federal standards, operates effectively, and is certified with the OMIG annually.
• Identifies potential areas of compliance vulnerability and risk, develops and implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
• Assure all reports made through the Whistleblower Procedure are fully investigated and results reported to the appropriate parties internally and the Board of Directors' Compliance Committee.
• Conduct proactive auditing and monitoring to ensure compliance with Medicare, Medicaid, and all federal, state & local regulatory requirements.
• Investigate and document reported compliance concerns and oversee completion of corrective actions plans.
• Manage the OIG exclusion and sanction screening process.
• Develop or recommend revisions to policies and procedures related to federal or state compliance requirements.
• Develop reports and metrics that demonstrate the effectiveness of the Compliance Program.
• Assure the standards of a high performing team member are followed and modeled daily.
• Assures the Board of Directors and the President/CEO is promptly informed of any serious breach of corporate compliance and the Compliance Committee of the Board receives routine reports of ongoing compliance activities and reviews.

SKILLS:

• Strong knowledge of healthcare laws, regulations, and positive experience in managing the 7 Elements of a Compliance Program including risk assessment and auditing.
• Ability to work effectively with consumers, their families, staff, and community contacts from a variety of cultural and ethnic backgrounds.
• Skilled in the use of personal computers and related software applications.
• Must be a strategic thinker and insightful decision maker with ability to analyze and solve problems.
• Ability to maintain confidential information.
• Excellent customer service skills.
• Demonstrated excellence in written and verbal communication.
• Strong facilitation, collaboration, and teamwork skills with the ability to build cross-functional partnerships to drive results.
• Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results.

EDUCATION REQUIREMENTS:

• Bachelor’s degree required; Masters or other advanced degree is preferred in a related field (health care administration, mental health counseling, social work, finance, CPA, etc.)
• MBA, MHA, or JD with major coursework in business administration, healthcare administration, or law desirable.
• Certified in Healthcare Compliance (CHC), Certified Compliance & Ethics Professional (CCEP), or certification in healthcare coding, preferred.

EXPERIENCE:

• Minimum five years’ experience in healthcare administration, compliance, or delivery, required.
• Three years of leadership/management experience.
• Experience with regulatory compliance in a health system setting strongly preferred.

Must possess a valid Driver’s License with an acceptable driving record

COMPENSATION: $75,194 - $91,687/yr