As a change agent and part of Grace Health, s/he will play a pivotal role in supporting the development and directing a high-performance healthcare risk and compliance program. This position will work closely with Directors, Officers, and other leaders to advance the internal risk and compliance reporting process for Grace Health. This individual will leverage his/her skills as a highly collaborative professional to help maintain and monitor all grant, Federal Tort Claims Act (FTCA), Patient Centered Medical Home (PCMH), Operational Site Visit (OSV), Controlled Substance (HB1), and any other key regulatory requirements that help improve health outcomes for patients and make a program impact. This includes working with stakeholders in multiple departments and collaborating with external organizations that impact the communities within our service areas. This position has day to day responsibility to the internal healthcare risk and compliance reporting process in support of the Grace Health strategic goals. This position reports to the COO.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Oversees and monitors Grace Health’s risk and compliance program.
- Develops and maintains relevant policies, procedures, audit tools, and training related to the risk and compliance program.
- Develops, implements, and maintains a compliance plan with Key Performance Indicators, (KPIs) based on requirements and risk.
- Ensures Grace Health’s policies and practices comply with federal and state laws/regulations and follow industry guidelines to prevent illegal, unethical, or improper conduct.
- Develops, presents, and manages an annual risk and compliance calendar identifying all requirements to be completed by Grace Health, including timetables and accountability measures.
- Assists with investigations and monitoring of compliance with entity privacy policies.
- Assists with gathering data and resources for Grace Health’s clinical policy management workflows.
- Works with Grace Health directors to ensure day-to-day operations of the program are established and are executed according to compliance plan. Partners with teams and staff to identify areas where risk and compliance input and guidance are required.
- In accordance with the risk and compliance program and plan, monitors clinical activities and conducts systematic audits for both risk and compliance with applicable rules and regulations to include HIPAA, Accreditation, CMS, and HRSA Compliance Manual. Identifies potential areas of risk and compliance vulnerability; develops/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.
- Gathers and submits data/documentation necessary when (applying/redeeming/re-certifications) for FTCA and PCMH.
- Communicates updates and changes on regulatory and legal changes including HRSA Compliance manual, FTCA, PINs, and Pals as directed.
- Responsible to participate in team-based preparation for HRSA OSV reviews, review preparation, coordination and follow-up.
- Develops and maintains an understanding of Federal, State, and local laws and regulations that impact Grace Health’s ability to provide patient care.
- Continually identifies company and event-based risk. Elevates such risk to Grace Health’s Executive Team.
- As part of the risk and compliance program, provides department, organization, and board dashboards.
- Oversees with Incident Reporting process and staff training for Grace Health. Ensures incident reports are accurate and responded to in a timely fashion. Through regular reports and dashboards, keeps Grace Health’s directors and officers updated on trends, concerns, and areas of improvements.
- Ensures the Grace Health Safety and Emergency Preparedness Team are educated on applicable compliance standards for FQHCs, HRSA, State Medicaid, and Medicare.
- Manages compliance investigations and resulting corrective action plans. Responds to alleged violations of rules, regulations, policies, procedures, and the Grace Health Code of Ethics by evaluating, recommending and following the investigative procedures
- Leads the compliance committee as an unbiased review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, resolved, and reported.
- Consults with general counsel as needed to resolve challenging legal compliance issues as directed.
- Manages all claims for the organization. Compiles and responds to all requests for claims related information. Works with local legal counsel to ensure timely and complete cooperation with the Department of Health and Human Services (DHHS) related to claims.
- Responsible for contract review and contract management.
- Perform other related duties as assigned by COO.
To perform this job successfully, an individual must be able to assist in advancing Grace Health’s mission and to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Intermediate-Advanced Computer skills – Microsoft Office (Word, Excel, PowerPoint, and Outlook).
- Clear and concise interpersonal and verbal communications skills and the ability to communicate effectively with a variety of personnel at all levels both internally and externally.
- Sound judgment and strong commitment to ethical conduct and integrity.
- Strong problem-solving skills with the ability to identify relevant risks and propose solutions that consider relevant business objectives and compliance concerns.
- Ability to work independently in a fast-paced and dynamic environment.
- Strong attention to detail, excellent organizational skills, and the ability to work on multiple projects with tight timelines.
EDUCATION and/or EXPERIENCE:
- Must have a bachelor’s degree in healthcare or paralegal degree and experience with legal counsel
- Experience in compliance and/or risk management in healthcare is strongly preferred
- 2 years of accreditation and FQHC experience is strongly preferred
- Working knowledge of HIPAA, HRSA, FERPA, CMS, False Claims Act, Anti-Kickback, OIG and state regulations strongly preferred
- Certified in Healthcare Compliance (CHC, CHPC, and/or CCEP) strongly preferred
- Nextgen Electronic Medical Record (EHR) experience strongly preferred
- Certified as a Patient Centered Medical Home Content Expert (PCMP_CCE) strongly preferred
Grace Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.