SUMMARY: The Director of Compliance (Director) works closely with management, staff, clients, and the Board of Directors to achieve the following goals:

• Adherence to federal, state, local laws and regulations, program requirements, organizational policies and procedures, contractual terms relevant to CFH’s book of business, and obligations outlined by healthcare payers in regard to participation, conditions of coverage, and reimbursement.
• Advancement of a safety culture that embodies CFH’s commitment to delivering excellent care and preventing harm to patients and staff.
• Continuous improvement of processes, systems, and controls through regular assessment of CFH’s clinical, financial, and operational activities; maintaining, or achieving compliance while simultaneously increasing efficiency.

To these ends, s/he assists the Senior leadership, other Directors, and staff in:

• Developing, implementing, and overseeing CFH’s Corporate Compliance Program, Risk Management Plan, and Safety Program; maintaining documentation as assigned.
• Facilitating open lines of communications that provide options for workforce members to ask questions, report problems, or share concerns in a retaliation-free environment.
• Investigating and acting on compliance and risk matters.
• Understanding and interpreting complex and intersecting healthcare laws and regulations; keeping abreast of ongoing changes and informing the organization of potential impacts.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Enhances, guides, and directs day-to-day operations of CFH’s compliance program; makes revisions in light of changes in organizational needs, or in the rules, regulations, and requirements of federal, state, and local healthcare authorities.
• Serves as CFH’s designated Compliance Officer; encourages employees to act ethically and to report any concerns or violations they may witness; ensures mechanisms are in place to manage instances of non-compliance; deters fraud, waste, and abuse by fostering open lines of communication.
• Develops and maintains written compliance plans, policies, and procedures; leads annual evaluation of the compliance program; ensures that all required elements are addressed; takes appropriate steps to improve program effectiveness.
• Formulates and facilitates compliance-related communications and education programs for the organization in conjunction with the Human Resources department and leadership; includes appropriate introductory, ad-hoc, and ongoing training for employees.
• Works closely with all areas to detect areas of compliance vulnerability by instituting and monitoring internal controls, conducting self-audits, and assessing risks arising from non-adherence to internal policies, protocols, external regulations, and program requirements.
• Liaisons with regulatory authorities to assist in coordinating, performing, and responding to external surveys, inspections, complaints, findings, and deficiencies. Regulatory authorities in scope including the Department of Homeless Services (DHS), Office of Temporary and Disability Assistance (OTDA), Department of Health (DOH), Office of Medicaid Inspector General (OMIG), Centers for Medicaid and Medicare Services (CMS), and Health Resources & Services Administration (HRSA).
• Evaluates findings from internal and external reviews, recommends process improvements, and creates corrective action plans for resolution of problematic issues. Partners with departmental leads to successfully document, implement, and track related activities in a timely manner; offers guidance on how to avoid or deal with similar situations in the future.
• Responds to alleged violations of rules, regulations, policies, and procedures by evaluating or recommending the initiation of investigative procedures; develops and oversees a system for uniform handling of such violations; acts as an independent body to ensure that compliance concerns within the organization are evaluated, investigated, and resolved by the appropriate parties.
• Oversees CFH’s incident reports and client feedback; reviews, tracks, and ensures appropriate follow-up and resolution. Performs regular analysis of data to identify and address gaps, concerning patterns, and significant trends; suggests quality and process improvements to incorporate related learnings into future states.
• Recommends, initiates, and reviews policies and practices to comply with all federal, state, and local regulations pertaining to corporate compliance, risk management, privacy, safety, and related areas. Continually analyzes the evolution of new legislation, regulations, and laws for impact on these areas; proposes strategic and tactical changes that needed to align with, and fulfill, requirements.
• Maintains an inventory of all agency policies and procedures; establishes periodic review and approval cycles.
• Secures the support of senior leadership; integrates the compliance program into CFH’s financial, clinical, and service operations; chairs and coordinates the compliance committee. Reports to the board on the progress and needs of the compliance program; highlights the compliance risks the entity faces; shares the methods through which CFH is addressing or can address those risks.
• Assists in the development and implementation of a semi-annual peer review of all clinical areas; analyzes data and prepares reports for presentation to the Chief Program Officer and Chief Medical Officer.

• Master’s degree, law degree a plus, or at least 5 years of related healthcare industry experience.
• Candidates with FQHC experience preferable.
• Candidates with Certification in Healthcare Compliance (CHC) preferable.
• General understanding of the public policy and legislative process.
• Experience with public healthcare and homelessness policy issues and related issues.

SKILLS:

• Strategic thinking, analytical aptitude, and creative problem-solving.
• Excellent communications skills, including written correspondence and oral presentations.
• Builds credibility and engenders trust across all levels of an organization; forges and nurtures effective working relationships with all levels of staff; works cooperatively and collaboratively.
• Exhibits strong project management skills, professionalism, grace under pressure, and perseverance.