SUMMARY: The Compliance Manager is responsible for incident resolution and prevention, audit, policy development, risk assessment and management, regulatory research, and work plan projects for our outpatient community health center setting. The Compliance Manager may also assist with the review and resolution of conflict of interest and other regulatory matters. Will be responsible for management of assigned internal compliance audits, recommendation and oversight of corrective action plans, and compliance education. Will interact with internal and external compliance stakeholders and must be critical-thinking, thorough, and solutions-focused.

JOB DUTIES AND RESPONSIBILITES:
To be conducted in accordance with WOHC Policies and Procedures

• Creating and implementing an effective compliance program
• Implement and administer compliance and monitoring programs, policies, and practices to ensure that WOHC complies with Joint Commission, HIPAA, and accreditation standards.
• Regularly review the compliance program and recommending appropriate revisions and modifications, including advising WOHC leadership and the board of directors of potential compliance risk areas
• Monitor and administer compliance with federal, state, and local regulators.
• Investigate potential compliance violations and take corrective action as necessary.
• Manage and oversee Risk Management program in conjunction with Risk and Safety Specialist
• Tracking all issues referred to the compliance office
• Develop and oversee control systems to prevent or deal with violations of legal guidelines and internal policies
• Collaborate with HR department to monitor enforcement of standards and regulations
• Review the work of health center staff when necessary to identify compliance issues and provide advice or training
• Keep abreast of regulatory developments within or outside of WOHC as well as evolving best practices in compliance control
• Prepare reports for Executive Team, Board of Directors, and external regulatory bodies as appropriate
• Manage patient experience surveys and report back survey responses
• Coordinate site reviews with federal, state, and local regulators for licensing purposes.
• Implement and operate retaliation-free reporting channels, including an anonymous telephone reporting system available to all employees, volunteers, customers, and vendors
• Developing educational programs for all employees, agents, contractors, or others working with the organization
• Performing other duties as assigned by the CEO

ORGANIZATIONAL VALUES:

Service Orientation: Demonstrates a commitment to serving internal and external customers and or patients. Consistently seeks ways to improve service delivery and communicates ideas to management as needed.

Communication: Communicates clearly, accurately, and concisely in verbal and written forms. Effectively adjusts communication to specific situations and diverse audiences to ensure information is understood. Work effectively with multi-cultural and economically diverse patients.

Teamwork: Provides meaningful contributions and actively participates in team activities. Works as part of the care team to provide evidence-based care, health coaching, self-management tools and proactively addressing the needs of patients and their families.

Quality: Actively participates in identify areas for improvement and establish methods for quality improvement.

MENTAL AND PHYSICAL DEMANDS:

• Pace of Work: High stress, very rapid, and demanding
• Concentration: Constant
• Standing and Walking Time Required: At least 50% of the time
• Time Speaking and Listening: 60% - 70%
• Environmental and Health Hazards: Frequent exposure to communicable diseases and other conditions common to a clinic environment.

The physical demands 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 regularly required to sit. The employee frequently is required to walk; use hands and fingers to operate a computer keyboard, mouse and telephone keyboard, and talk or hear. The employee must occasionally bend, lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and ability to adjust focus.

POSITION DESCRIPTION REVISIONS

This is not necessarily an exhaustive list of all responsibilities, skills, duties, requirements, efforts or working conditions associated with these roles. While this is intended to be an accurate reflection of the current Position, management reserves the right to revise the Position or to require that other or different tasks be performed when circumstances change. This Position description replaces all previous Position descriptions for this position.

BENEFITS

• Employer Funded Retirement Plan
• 403b
• Free Medical (Kaiser or Sutter), Dental and Vision
• Free Life Insurance
• License, Certification, and Registration Reimbursement
• Reimbursement for approved courses and seminars
• EAP Program
• Discounts on programs through partnered companies such as Legal Shield, ID Shield, and AFLAC

• Epic EMR experience
• Proficiency with Microsoft Word, Excel, and SharePoint
• Policy and procedure development
• Familiarity of Medicare and Medicaid billing rules and guidelines, CPT and ICD coding guidelines
• Culturally sensitive and demonstrated ability and effectiveness working with ethnically diverse populations.
• Must be willing to travel to and from various service sites, including offsite visits, as needed.
• Self-starter with attention to detail and ability to manage multiple projects, delivering timely, exceptional, and thorough work products
• Ability to provide guidance and direction on department initiatives
• Desire to continue to expand skill sets and experience and willingness to take on new projects
• Excellent interpersonal, written, and verbal communication skills
• Ability to perform independent research and factual analysis of compliance matters and create proposed solutions to root causes
• Ability to function within a fast-paced, dynamic, and growing environment
• Ability to maintain patient confidentiality
• Familiarity of federal and state regulations, such as False Claims Act, Stark Law, Anti-Kickback Statute, Civil Monetary Penalties Law, and HIPAA
• New hires must be fully vaccinated against the COVID-19 virus by the date of hire.

EDUCATION AND EXPERIENCE:

• Bachelors degree in health/public/business administration, public policy, health information management, or related field required.
• Advanced degree in a related field (such as MHA, MPA, MBA, JD) preferred.
• 2-6 years experience in a healthcare (or translatable) setting with compliance programs, regulatory research, auditing, and/or policy and procedure development required.
• Experience in management of compliance programs preferred.
• Required Licenses/Certifications:
• Certified in Healthcare Compliance (CHC) desired at time of or within 18 months of hire.
• Other desired certifications: Certified in Healthcare Privacy Compliance (CHPC); Certified Professional Coder (CPC); Certified Coding Specialist (CCS).