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Director of Compliance

Alameda Health Consortium/Community Health Center Network San Leandro, CA

  • Expired: over a month ago. Applications are no longer accepted.
Job Description

Organizational Description

The Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County.  CHCN functions as the managed care MSO for our health centers, contracting with the Alameda Alliance for Health and Anthem Blue Cross.  In order to help our health centers meet their missions of providing the best possible care to their communities, we also provide a broad range of training, technical assistance, quality improvement, information technology, and data analytic services.

 

Position Title:    Director of Compliance  

Department:     Compliance  

Reports To:       Chief Operations Officer

Classification:    Exempt   

Status:             Full-Time Regular 

 

POSITION SUMMARY

The Director of Compliance has the overall responsibility for the compliance program at AHC/CHCN; including the development and implementation of the AHC/CHCN Compliance and Regulatory Plans and overseeing organizational response to contracted plan audits.  This is a hands-on role requiring both strategic thought and direct attention to detail.  The Director of Compliance is responsible for ensuring agency compliance with all state, federal, and local regulations, and organizational contracts and policy and procedures, and audit control/inspections.  This is a key and highly visible agency position with the responsibility of developing and maintaining a strong corporate compliance program and culture within the agencies.  The position works in a consultancy role with member health centers.

 

ESSENTIAL POSITION RESULTS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities. Employees may perform other duties as assigned. 

 

•Annually prepare the Corporate Compliance Plan, implement and take responsibility for all reporting requirements contained within the plan.

•Prepare an annual work plan addressing the priority compliance risk exposures for review by the Compliance Committee.

•Revise the Compliance Plan as dictated by changes in statutes, rules, regulations and requirements of Federal, state and health plans.

•Organize and lead efforts regarding all partner Health Plan delegation, NCQA, DMHC and DHCS compliance audits.

•Develop and maintain audit response policy and procedure workflow and organizational structure across the network.

•Formulate, review and revise appropriate compliance policies and procedures.

•Monitor and ensure adherence to policies and procedures for MSO.

•Develop, coordinate, and participate in educational and training programs that focus on the elements of the Compliance Program.

•Ensure that all appropriate employees and managers are knowledgeable of, and comply with, pertinent Federal, State and payer health care program requirements.

•Conduct independent and on-going audits to ensure compliance with Federal, State, and payer health care programs.

•Maintain the Compliance hot-line, responding to any calls immediately and conducting any necessary investigation.

•Lead the Compliance Committee and periodically report to the Board of Directors.

•Develop and implement methods and programs that encourage managers and employees to report possible noncompliance without fear of retaliation.

•Coordinate with other department heads to ensure seamless implementation of policies and procedures between Compliance and Operations.

•Maintain current knowledge of all state and federal regulations affecting the operations of the MSO.

•Provide quarterly updates to the CEO regarding progress toward the Compliance plan and results of related audits and monitoring functions.

•Identify high risk areas to reduce agency’s vulnerability to fraud, waste and abuse.

•Develop, coordinate and participate in educational program for all employees to ensure all have knowledge of and comply with pertinent Federal and State standards as well as all internal policies and procedures.

•Establish relationships with member health center compliance staff and provide consultative resources as requested.

•Plan the agenda and facilitate monthly/quarterly meetings with Compliance staff from member health centers.

•Complete special projects as assigned.  

 

HIPAA Designated Access

“For the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets”    

 

1. MSO Membership    2. MSO Claims    3. MSO Referral/Auth.    4. MSO Capitation

5. Data Warehouse      6. Chart Audit/QI  7. Disease Registry

 

SUPERVISORY RESPONSIBILITIES

Yes

 

MINIMUM QUALIFICATIONS

Competencies 

•Ability to make meaningful observations and write comprehensive and accurate reports.

•Self-starter who is comfortable making key decisions and holding others accountable for compliance standards.

•Ability to translate/provide cogent advice to senior management regarding the impact of emerging industry trends in compliance enforcement, legislation and regulations on affiliate business strategies.

•Must understand and lead by communicating vision, exhibiting decisiveness, sponsoring change and supporting the larger organization success.

•Knowledge of Federal, State and health plan statutes, rules and regulations.

•Must exhibit a credible leadership presence, with the ability to respond to questions with logic, clarity, calmness and authority, leading to desired support of/actions by others.

•Proven leadership skills in a healthcare compliance environment.

•Ability to work well with others to ensure the highest ethical standards.

•Knowledge of operations and the flow of information throughout a health plan or MSO organization.

 

EXPERIENCE/EDUCATION/CERTIFICATES AND/OR LICENSES

•Graduate degree in healthcare administration or equivalent experience.

•Minimum of 5 years’ experience in healthcare compliance or related exposure to managed care with FQHC knowledge highly desirable.

•Experience in a Knox Keene licensed environment highly desirable.

•Healthcare compliance certification preferred. 

 

PHYSICAL DEMANDS 

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 and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is frequently required to stand; walk; reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 15 pounds.  Specific vision abilities required by this job include close vision and ability to adjust focus.

WORKING CONDITIONS AND ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing 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 exposed to an inside environment.

 

The Community Health Center Network is an Equal Opportunity Employer.

Alameda Health Consortium/Community Health Center Network

Address

San Leandro, CA
94577 USA

Industry

Business

View all jobs at Alameda Health Consortium/Community Health Center Network