Corporate Compliance Officer
- Compliance Program Development and Implementation:
- Create and maintain a compliance program that addresses the seven elements of a comprehensive compliance program. This includes:
- Clear and documented guidelines outlining expected behavior and compliance standards across the organization.
- Designated individuals with responsibility for overseeing the compliance program, including risk assessments, training, and investigations.
- Regular training sessions for all employees covering relevant compliance regulations, policies, and ethical conduct.
- Open and accessible communication channels for employees to report potential compliance concerns without fear of retaliation.
- Regular reviews and assessments to identify potential compliance risks and ensure adherence to policies.
- Established disciplinary actions for violations of compliance policies, clearly communicated to all employees.
- A system for timely investigation and corrective action when compliance issues are identified.
- Conduct regular compliance audits to monitor adherence to policies and regulations. Conduct risk assessments to identify potential compliance vulnerabilities within the organization.
- Analyze billing data and medical records to identify potential compliance issues.
- Investigate complaints or suspected violations of compliance policies.
- Report compliance concerns to senior management and the compliance committee (PACE SEMI Board of Trustees).
- Communicate compliance updates and policy changes to relevant staff members.
- Collaborate with legal counsel on complex compliance matters.
- Promote a culture of compliance through open communication and employee engagement.
- Work closely with various departments including clinical operations, health plan management, finance, IT, and legal to address compliance concerns.
- Maintain relationships with regulatory agencies and stay updated on industry compliance trends.
- Established procedures for voluntarily self-reporting fraud or misconduct related to the PACE program to CMS and the State administering agency.
- Bachelor’s degree in healthcare related field. Masters preferred.
- Strong understanding of PACE & healthcare regulations, including HIPAA, Stark Law, Anti-Kickback Statute, and Medicare/Medicaid guidelines.
- 5 plus years of experience in compliance auditing and risk assessment methodologies.
- Excellent communication and interpersonal skills to effectively train and educate staff.
- Legal and analytical skills to interpret complex regulations and investigate compliance issues.
- Ability to collaborate with diverse stakeholders within and externally.
- Healthcare industry experience, preferably in a clinical or administrative role.
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