- Expired: over a month ago. Applications are no longer accepted.
Reporting to the Detroit Wayne Integrated Health Network (DWIHN) Board of Directors and the Chief Executive Officer of DWIHN, the Compliance Officer oversees DWIHN’s Compliance Program. This position functions as an independent and objective body that reviews and evaluates compliance issues/concerns within the Detroit Wayne Integrated Health Network (DWIHN). The Compliance Officer ensures that the Board, management and employees are following the rules and regulations of regulatory agencies, that DWIHN policies and procedures are being followed, and that behavior in the organization meets the Network’s Standards of Conduct.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Develops, initiates, maintains and revises policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical or improper conduct.
- Manages day-to-day operations of the compliance program.
- Develops and periodically reviews and updates Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.
- Responds to alleged violations of rules, regulations, policies, procedures and standards of conduct by evaluating or recommending the initiation of investigative procedures.
- Develops and oversees a system for uniform handling of such violations.
- Acts as an independent review and evaluation body to ensure that compliance issues and concerns within the organization are being appropriately evaluated, investigated and resolved.
- Serves as a channel for communication to receive and direct compliance issues to appropriate resources for investigation and resolution.
- Serves as a final internal resource with which concerned parties may communicate after other formal channels and resources have been exhausted.
- Collaborates with other departments (for example, human resources, HIPAA security officer and Chief Information Officer) to direct compliance issues to appropriate existing channels for investigation and resolution.
- Consults with general counsel as needed to resolve difficult legal compliance issues.
- Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
- Identifies potential areas of compliance vulnerability and risk, develops and 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.
- Provides compliance and other related reports.
- Informs the Corporate Compliance Committee and senior management of the operation and progress of compliance efforts.
- Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate or required.
- Establishes and provides direction and management of the compliance hotline.
- Institutes and maintains an effective compliance communication program for the organization, including promoting a) use of the compliance hotline, b) heightened awareness of standards of conduct, and c) understanding of new and existing compliance issues and related policies and procedures.
- Works with the human resource department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees and ongoing training for all employees and managers.
- Monitors the performance of the compliance program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.
- Routinely monitors changes in the applicable Health Insurance Portability and Accountability Act (HIPAA) government regulations.
- Researches and analyzes available sources of regulatory guidance in response to specific questions.
- Monitors available sources of regulatory guidance to proactively address the necessary changes to the HIPAA compliance implementation plan based on documentation and feedback.
- Responds to specific questions that affect the HIPAA compliance implementation plan, with recommendations that are supported by applicable regulatory and/or government and Network policy guidance.
- Maintains a strong working knowledge of applicable regulatory guidelines
- Coordinates with the appropriate administrative and support departments to adequately design an implementation plan, policies and analyze the effects of any proposed process changes required by HIPAA.
- Coordinates the systematic reviews of the various departments' HIPAA compliance status.
- Performs related duties as assigned.
KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)
- Knowledge of requirements under Corporate Integrity Agreements (CIAs) and Certificate of Compliance Agreements (CCAs), HIPAA, and the Emergency Medical Treatment and Labor Act (EMTALA).
- Knowledge of health care fraud and abuse laws, including the False Claims Act, Stark Laws, and the Anti-Kickback Statute, including the associated penalties.
- Knowledge of health care law, regulations and standards.
- Knowledge of coding and reimbursement systems, risk management and performance improvement.
- Knowledge of governmental compliance regulations.
- Knowledge of DWIHN policies, procedures and practices.
- Knowledge of the DWIHN provider network and community resources.
- Knowledge of the Michigan Mental Health Code.
- Knowledge of MDHHS policies, rules, regulations and procedures.
- Knowledge of Federal policies, rules, regulations and procedures as it relates to DWIHN.
- Knowledge of NCQA requirements and the accreditation process.
- Knowledge of the principles and methodology of total quality management (TQM)/ continuous quality improvement (CQI), specifically the PDSA/PDCA Cycle, quality tools and techniques, and models for improvement.
- Knowledge of contracting policies and procedures.
- Knowledge of HIPPA Compliance.
- Supervisory skills.
- Management skills.
- Leadership skills.
- Executive skills
- Project management skills.
- Strategic thinking skills.
- Critical thinking skills.
- Planning skills.
- Emotional intelligence skills.
- Mediation skills.
- Ethical decision-making skills
- Rational decision-making skills.
- Corrective Action skills.
- Assessment skills.
- Organizational skills.
- Planning skills.
- Accuracy skills.
- Analytical skills.
- Time Management skills.
- Report writing skills.
- Logical skills.
- Reasoning skills.
- Problem Solving skills
- Decision Making skills.
- Presentation skills.
- Interpersonal skills.
- Public Speaking skills.
- Multitasking skills.
- Prioritizing skills.
- Computer skills
- Teamwork Skills
- Ability to communicate orally.
- Ability to communicate in writing.
- Ability to work effectively with others.
- Ability to act ethically and with confidentiality.
- Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
- Judgement/Reasoning ability.
A Master’s degree in Business Administration, Healthcare Administration, Public Administration or related field or a Juris Doctorate.
Five (5) years of professional experience as a Compliance Officer for a Health Care Organization or closely related experience.
A valid State of Michigan Driver’s License with a safe and acceptable driving record.
Certification as a Healthcare Compliance Officer (CHC) through the Health Care Compliance Association. (Preferred)
Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.
This description is not intended to be a complete statement of job content, rather to act as the essential functions performed. Management retains the discretion to add or change the position at any time.
The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer
Detroit Wayne Mental Health Authority
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