Job Description:
Job Summary:
The FQHC Compliance Partner is responsible for the effective implementation and coordination of the compliance policies within assigned regions or service lines and serves as the region or service line’s resource for corporate compliance related matters.
The Compliance Partner is responsible for carrying out the day to day compliance activities within their assigned region(s) or service line(s) in regards to: Developing and coordinating relevant and meaningful corporate compliance trainings and programs; Investigating and responding to reports of misconduct or non-compliance; Identifying trends and patterns of non-conformance with laws, regulations or corporate policies within the service line and developing, monitoring and implementing mitigation strategies in areas identified; Monitoring the effective implementation of corrective action plans and assisting with the revision of compliance reporting, investigation and appeal policies and procedures.
Essential Job Functions:
Compliance Policies, Procedures and Practices
Keep abreast of laws, regulations, corporate policies and procedures, best practices and monitor practices to identify areas of non-conformance and work collaboratively with regional or service line leadership and administration to implement best compliance practices in a meaningful and relevant way throughout the jurisdiction.
Regularly monitor regional or service line compliance related activities and work with service line leadership to develop and implement mitigation strategies in regard to practices identified as being at risk for non-compliance and ensure maintenance of documentation.
Works in conjunction with the Vice President of Compliance Culture and the compliance team to ensure consistent and effective implementation of compliance policies and initiatives.
Work in conjunction with Human Resource Partners to develop metrics to regularly monitor new employees, acknowledge the above compliance policies within thirty days of hire and submit analysis and any proposed corrective actions to the Vice President of Compliance Culture on a regular basis.
Compliance Training and Education
Collaborate with the Vice President of Compliance Culture on development/modifications of orientation and annual core compliance training for associates and contracted providers. Training should effectively educate associates and contracted providers on compliance policies and procedures, reporting possible breaches of PHI, and possible sanctions for violation. Core compliance trainings should be tailored to relevant audiences and learning styles.
Collaborate with the Vice President of Compliance Culture to identify associates in high risk compliance areas and additional compliance trainings that they will be required to complete. Develop metrics to regularly monitor high risk employees; ensuring they have completed required trainings and report to the Director of Compliance Administration on a regular basis.
In collaboration with the Vice President of Compliance Culture, identify metrics to regularly monitor associates are completing core compliance training and attesting to awareness of the Code of Conduct and how to access the hotline on an annual basis. Regularly analyze metrics, and submit analysis and any proposed corrective action steps to the Director of Compliance Administration on a regular basis.
Assist and support regional and service line leadership and Human Resources on associates timely completing annual core compliance trainings and attestations as necessary. Follow up with associates directly as necessary.
In collaboration with the Vice President of Compliance Culture, identify metrics to regularly monitor new associates are completing core compliance training and attesting to awareness of the Code of Conduct and how to access the hotline within thirty days of hire. Regularly analyze metric, and submit analysis and any proposed corrective action steps to the Vice President of Compliance Culture on a regular basis.
Develop and assist in writing compliance articles for the newsletter.
Collaborate with regional and service line leadership and compliance staff to develop, document and present relevant on-going compliance related/billing in-service trainings and programs targeted to trends, billing or high-risk concerns identified in jurisdiction.
Compliance Investigations
Timely investigate and/or respond to hotline calls, complaints, and reports on misconduct or nonconformance with laws, regulations or corporate policies.
Travel to sites to investigate matters by interviewing staff, persons served.
For each investigation, prepare a timely final investigative report that thoroughly documents the investigation, provides sufficient evidence and references to laws, regulations and corporate policies to support the analysis and conclusion, and includes recommendations.
Maintain objectiveness and independence at all times. Recognize conflicts of interest as they arise and recuse oneself immediately from the situation.
Analyze information gathered by investigation and make appropriate findings, including root cause analysis.
Debrief with the Vice President of Compliance Culture and appropriate leadership following investigation as necessary.
Track trends and patterns of compliance related activity in jurisdiction. Analyze and report regularly to the Vice President of Compliance Culture.
In collaboration with Human Resource Partners, ensure consistent associate sanctions are appropriately applied and documented consistent with policies and procedures and report to the Vice President of Compliance Culture.
Oversee and monitor the effective implementation of corrective action plans related to sentinel events. Maintain documentation of corrective action plans management implements in response to other compliance related investigations or events.
Focused Auditing/Monitoring/Trending
Monitor associates’ knowledge of how to access compliance policies and procedures and awareness of the Code of Conduct and report to the VP of Compliance Culture on a regular basis.
Monitor associates’ knowledge of the non-retaliation policy and report to the VP of Compliance Culture on a regular basis.
Monitor associates knowledge, awareness and use of the Corporate Compliance Hotline and Compliance reporting policies and report to the VP of Compliance Culture on a regular basis.
Regularly monitor compliance contacts and investigations for trends and patterns.
Analyze and report to the VP of Compliance Culture on a regular basis.
Other Responsibilities
Regularly and strategically visit offices, attend employee functions and participate in office activities.
Demonstrate interest in long term and short-term goals and objectives of the company.
Demonstrate personal strict adherence to the Code of Conduct both during and after business hours.
Continuing Education
Other duties as assigned by the VP of Compliance Culture.
Knowledge, Skills, and Abilities:
Ability to interact and work with people effectively.
Excellent verbal and written communication skills with ability to mediate, compromise, and collaborate in order to work with and in several related teams of people.
Knowledge of the field of service provision.
Ability and willingness to grasp and implement regulatory, certification, licensing and accreditation standards and indicators.
Ability and willingness to understand and implement HIPAA, Code of Conduct and 42.CFR standards and indicators.
Ability to maintain consistent work quality.
Ability to proficiently use Microsoft Word, Excel, PowerPoint and learn Electronic Health Record systems.
Ability to use spreadsheets and reports for tracking and presenting information.
Ability to manage multiple priorities and concurrent projects and meet reasonable deadlines.
Strong interviewing, researching, and analytical skills and techniques specific to corporate investigations.
Familiar with coding, billing and clinical documentation requirements and standards.
Able to work confidently in a fast-paced, demanding environment.
Demonstrated basic computer skills including familiarity with Microsoft Word and Excel programs.
Ability to travel including overnight stays.
Experience and Education Qualifications:
Bachelor's degree from an accredited college or university required. Master's or Juris Doctor (JD) preferred
Experience in FQHC required, or Mental Health and/or Substance Use Disorder services, preferred.
Experience in healthcare related compliance, preferred.
Experience with compliance related software.
Supervisory Requirements:
None
Employment Requirements:
Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.
Completion of New Hire Orientation at the beginning of employment.
All training requirements including Relias at the beginning of employment and annually thereafter.
Current driver’s license, acceptable driving record and current auto insurance.
Physical Requirements:
ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift.
Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.
Brightli is a Smoke and Tobacco Free Workplace.