Description

General Description

The Compliance Officer is responsible for oversight of all quality management activities including quality assurance, quality improvement, corporate compliance, incident management, and meeting all regulatory requirements for the agency and all programs for Catholic Charities Family and Community Services (CCFCS). In addition, the Compliance Officer is responsible for identifying and guiding organization through quality improvement efforts and measurements as identified in strategic plan and to ensure CCFCS is continually executing quality services. Effectively supports ongoing and collaborative communication amongst all program staff and is responsible for ensuring a trauma informed care environment.

Essential Duties and Responsibilities

• Serve as the Agency Privacy Officer which includes oversight of privacy policies and procedures, related training and serve as a resource to all employees for HIPAA matters.
• Serve as the Agency Compliance Officer to support and promote a proactive approach toward potential compliance issues.
• Provide development, oversight, monitoring, required updates and training of all employees, Board, and contractors of the Compliance Program.
• Participate in all Diocesan-wide Corporate Compliance Committee meetings and activities.
• Work closely with the Regional Compliance Officers from the other Catholic Charities Diocese of Rochester (CCDR), and the CCDR Chief Compliance Officer to ensure consistency with compliance matters across the CCDR agencies.
• Provide direct supervision to the Director of Quality and Incident Management
• Provide administrative oversight to the Quality Management and Compliance Department including, but not limited to, hiring, evaluating, training, evaluation, and promoting ongoing staff development.
• Collaborate with HR to ensure appropriate actions are taken when any employee fails to follow policies and procedures, including coaching, retraining, corrective discipline and/or termination of employment.
• Oversee the recruitment and supervision of student and volunteer placements in QM department.
• Serve as primary staff liaison to the CCFCS Board of Directors Quality and Compliance Committee and report all compliance concerns and progress with the annual compliance work plan and audit plan.
• Develop quarterly trend reports for the CEO and CCFCS Board of Directors Quality and Compliance Committee including, compliance, HIPAA, incident, and audit activities and findings.
• Ensure all reports of potential fraud, waste, or abuse related to billing for services are thoroughly investigated, appropriate corrective actions are implemented, and Self-Disclosures are completed and submitted to the Office of the Medicaid Inspector General as required.
• Act as administrator for the CCDR compliance hotline and ensure all reports are assigned to the appropriate agency and investigator..
• Collaborate with the Human Resources Director/Designee for all matters pertaining to employees involved with investigatory activities for potential abuse/neglect of a service recipient, fraud/waste/abuse, or other violations of compliance program, code of conduct, policies and procedures, or other regulatory requirements.
• Serve as contributing member of CCFCS Senior Executive Team, offering strategic thinking, planning, and execution for the overall organization.
• Provide direction, strategic planning and oversight, macro level leadership and future direction planning for all quality management and compliance programs for the agency.
• Conduct annual agency-wide risk assessment and effectiveness review and provide feedback and findings to the leadership team.
• In coordination with Department Directors, develop, recommend, and oversee policies and procedures for all programs and monitor for training and implementation of all CCFCS employees.
• Coordinate the development, implementation, and fiscal accountability of the budgets for the QM department.
• Monitor all purchases and expenses for QM department.
• Oversee development and monitoring of Quality Improvement initiatives, including Service Excellence Plans, for all programs and services.
• Conduct and coordinate program evaluation and quality improvement activities within the programs for all departments and agency.
• Conduct and provide backup coverage for QM staff for all planned or required QM activities, including but not limited to audits, investigations, and completion of compliance workplan objectives.
• Oversee completion of all reports related to QM required for all programs, agency, and funding sources.
• Network with other organizations, agencies, and service providers to foster community collaboration in implementing best practices for Compliance, Privacy, and QM activities for agency.
• Provide oversight and serve as contact for all reporting systems used for QM Department including but not limited to, IRMA, NIMRS, CCFCS Incident Database, WISR.
• Oversee all agency internal audits established to monitor effectiveness of compliance standards and provide feedback as appropriate.
• Provide general oversight of the CCFCS Incident Review Committee and act as designee for CEO with the selection of committee members.
• Provide general oversight for agency safety, emergency response, and risk management and monitor for staff compliance with completion of required training.
• Attend mandatory training and conferences.
• Monitor completion of mandatory trainings by each employee in every department and reports non-compliance to Senior Executive Team members as appropriate.
• Provide crisis intervention and on-call support.
• Represent Catholic Charities on appropriate committees, boards, and task forces.
• Ensure compliance with all applicable local, State and Federal regulations and agency policies.
• Participates in relevant Agency meetings and/or trainings.
• Actively pursues development of professional competencies related to job role performance through reading, supervision, in-service training and attendance at conferences and workshops.
• Awareness and active support of the Agency's Mission, Vision, Values and Strategic Plan. Including, but not limited to, supporting the Agency's Core Competency initiatives of being Collaborative and Community Focused, Innovative and Entrepreneurial, and Culturally Competent and Diverse
• Other duties as assigned.

The Compliance Officer has the authority to review all documents and other information relevant to compliance activities, including but not limited to, client records (where appropriate), billing records and records concerning the marketing efforts of the facility and the organization’s arrangements with other parties, including employees, professional staff, relevant independent contractors, suppliers, agents, supplemental staffing agencies and physicians. In addition, the Compliance Officer should be copied in on the results of all audit reports, internal and external, and work closely with key managers to identify aberrant trends in coding and billing areas as well as regulatory deficiencies. The Compliance Officer has full authority to stop the processing of claims he/she believes to be problematic until such time as in the issue in question may be resolved.

Note: The above description is illustrative of tasks and responsibilities. It is not meant to be all inclusive. Employees are required to follow appropriate supervisory direction and perform other related duties as required.

Qualifications

Qualifications

Education: Master’s degree in health and/or Human Services or related field, Public Administration or Organizational Management. Equivalent combination of education and experience will be considered.

Credentials: Certified in Healthcare Compliance (CHC) Preferred

Experience: At least 5 years of experience working in a Quality Management/compliance function for an organization under the oversight of OASAS, OCFS, OMH, OPWDD, or DOH. Experience with multiple regulatory oversight agencies is preferred.

Physical Demands/Work Environment: The physical demands/work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is frequently required to sit, talk, hear, stand, walk, use hands to type and/or perform light lifting. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus.The noise level in the work environment is usually quiet.

Compliance: Adheres to all applicable federal and state laws and regulations including, but not limited to, those governing confidentiality, privacy, program, billing, and documentation standards. All duties must be performed in accordance with CCFCS’s corporate compliance & ethics program.

Additional Requirements: