Compliance Officer

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Compliance Officer
Duties: Develops, directs and maintains the Compliance Program. Chairs and maintains documentation of the QAPI team and reports monthly with Health Board Compliance Committee and coordinates with Legal Counsel as needed. Develops, administers and monitors implementation of the wide plan to comply with state, federal and accreditation requirements, including but not limited to Medi-Cal, Medicare, HIPAA, OSHA, and IHS. Works with managers in preparation, development and implementation of written policies and procedures to achieve compliance with state, federal and accreditation standards. Ensures compliance with revenue generation and reimbursement rules and regulations from CMS and other federal or state funded health care programs. Determines the degree to which meets/exceeds compliance standards through audits and other surveillance tools. Ensures that the medical staff appointees and independent contractors are in compliance with applicable standards, especially with regard to credentialing, coding, and billing practices. Coordinates the processing of internal and external compliance complaints with the QAPI team and Health Board Compliance Committee. Recommends and implements resolution strategies for identified compliance issues. Performs compliance assessments in clinical settings and inspects patient care areas. Collaborates with quality and safety personnel to investigate potential or actual occurrences/incidents and necessary reporting. Ensures Compliance Program effectively prevents and/or detects violations of law, regulations, policies, and applicable codes of conduct. Implement and maintain education programs, internal controls, retaliation-free reporting channels, and tracking system for orientation, trainings, investigations and resolutions. Oversees compliance related corrective action plans to ensure follow through to resolution.

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