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Years of Experience
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ProfileDirector, Compliance and Privacy The candidate will oversee the Health compliance program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. The position ensures the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies, that the necessary company policies and procedures are in place and being followed and that behavior in the organization meets the company's standards of conduct. Will be the focal point of all compliance activities and should be viewed by all employees, managers and contractors as a valuable and confidential resource for questions related to compliance. Serve as a role model to all Beacon Health employees and partners, including through demonstrating the highest levels of professionalism, integrity, and ethical behavior. Ensure that company conducts its activities in compliance with all federal, state and local laws and regulations and in conformance with the highest standards of business integrity. Design, implement and maintain company’s compliance program to help all members, partners, participants, participant employees, managers and contractors achieve these objectives by establishing general overall framework for conducting our activities with integrity and accountability pursuant to a shared set of ethical and legal principles. Ensure the company is compliant with all of its contracts and agreements including but not limited to CMS (Pioneer/Next Gen); CMS Medicare Shared Savings Program; MaineCare risk contracts, Commercial payor arrangements; Employer; Vendor and Consulting contracts. Establish processes and policies that ensure compliance with marketing to beneficiaries and managing participating provider files. Collaborate with company member/partner organizations regarding local policies that support the ACO compliance activities. Oversee all day to day aspects of the ACO's compliance program. Ensure the effectiveness of the compliance program through auditing and monitoring. Develop and maintain a compliance auditing/monitoring plan for the organization based on an objective risk assessment. Conduct internal audits, reviews, and other investigations. Document all corrective action and reports these findings to the VP Chief Compliance Officer and Board of Directors no less than quarterly. Oversee the development, implementation, maintenance and adherence of and to the organization's policies and procedures in compliance with federal and state laws and regulations as well as ethical standards, including related to privacy and information security. Promote open and non-punitive communication between healthcare workers, patients and families regarding clinical and environmental safety. Publicize and maintain a reporting system whereby employees can report compliance issues and concerns without fear of retaliation. Respond to requests for evaluation of issues from employees within the organization. Act as a facilitator for the investigation and subsequent resolution of any issues. Follows established company protocols for all investigation activities. Manage compliance audit requests from all external entities, including CMS, MaineCare, Commercial payers, etc. Monitor compliance with legal and accrediting requirements related to areas of responsibility functions and services. (e.g., NCQA Care Management Certification). Work collaboratively with Information Systems and security personnel on compliance with FISMA and HIPAA. Assist management and legal counsel with contract development to assure compliance with applicable licensure requirements, laws and regulations. Work with human resources personnel to monitor and ensure the consistent enforcement of compliance expectations through appropriate disciplinary action. Work with human resources personnel to ensure proper background checks are performed when required. Institute and maintain an effective Beacon Health Compliance Communication program, including promotion of the (a) use of the "hotline", (b) heightened awareness of the organization Code of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. Maintain a strong awareness of existing laws and regulations affecting Beacon Health while keeping abreast of current changes that may affect healthcare systems and accountable care organizations. Inform the employee population regarding these compliance matters through personal initiatives, seminars, training programs, peer contact, and other education efforts. Assist the company leadership team in program planning and development of Business Plans. Provide analysis of business plans and budget as requested. Create a self-development plan to improve leader skills, competence, and outcomes. Serve as the Privacy Officer. Work closely with other company Member compliance and privacy officers, including actively participating as a member of the company’s Compliance Task Force. Identify issues that require input from and/or approval of company's Legal Services and referring these issues for legal review and resolution. Assist Legal Services in analyzing company related legal and compliance issues.
Qualification and Experience
Bachelor's degree required. Master's degree in healthcare related field preferred. Law degree strongly preferred. 5+ years of experience in health care compliance or management preferred. Thorough knowledge of hospital or medical group operations preferred. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations preferred.