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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileChief Compliance and Privacy Officer Duties: Will oversee organization's compliance program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. Ensure the Board of Trustees, management and employees are in compliance with the rules and regulations of regulatory agencies, that company policies and procedures are being followed and that behavior in the organization meets the company’s standards of conduct. While ultimate responsibility and oversight of the ACO’s compliance activities rests with the Board of Trustees, organization's Chief Compliance and Privacy Officer is the focal point of all compliance activities and should be viewed by all employee members, managers and contractors as a valuable and confidential resource for questions related to compliance. By adhering to these principles, organization will achieve the legal compliance required under the law and to which the Board of Trustees expects all members, partners, participants, participant employees, managers and contractors to adhere. Will be responsible for ensuring that organization. Conduct its activities in compliance with all federal, state and local laws and regulations and in conformance with the highest standards of business integrity. Designing, implementing and maintaining Beacon Health’s compliance program to help all members, partners, participants, participant employees, managers and contractors achieve these objectives by establishing general overall framework for conducting activities with integrity and accountability pursuant to a shared set of ethical and legal principles. Ensuring organizationis compliant with all of its contracts and agreements including CMS (Pioneer/Next Gen); CMS Medicare Shared Savings Program; MaineCare risk contracts, Commercial payor arrangements; Employer; Vendor and; Consulting contracts. Establishing processes and policies that ensure compliance with marketing to beneficiaries and managing participating provider files. Collaborating with organization member/partner organizations regarding loc al policies that support the ACO compliance activities. Overseeing all day to day aspects of the ACO’s compliance program. Ensuring the effectiveness of the compliance program through auditing and monitoring. Develops and maintains a compliance audit plan for the organization based on an objective risk assessment. Conducts internal audits, reviews, and other investigations. Documents all corrective action and reports these findings to the EMHS Chief Compliance Officer and Board of Directors no less than quarterly. Overseeing 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. Promoting open and non-punitive communication between healthcare workers, patients and families regarding clinical and environmental safety. Publicizes and maintains a reporting system whereby employees can report compliance issues and concerns without fear of retaliation.Responding to requests for evaluation of issues from employees within the organization. Acts as a facilitator for the investigation and subsequent resolution of any issues. Follows established EMHS protocols for all investigation activities. Managing compliance audit requests from CMS, MaineCare and Commercial payers. Monitoring compliance with legal and accrediting requirements related to areas of responsibility functions and services. (e.g., NCQA Care Management Certification). Working collaboratively with Information Systems and security personnel on compliance with FISMA. Assisting management and legal counsel with contract development to assure compliance with applicable licensure requirements, laws and regulations. Working with human resources personnel to monitor and ensure the consistent enforcement of compliance violations through appropriate disciplinary action. Working with human resources personnel to ensure proper background checks are performed when required. Instituting and maintaining an effective organization; compliance Communication program, including promotion of the use of the “hotline”, heightened awareness of the organization Code of Conduct, and understanding of new and existing compliance issues and related policies and procedures. Maintaining a strong awareness of existing laws and regulations affecting organization while keeping abreast of current changes that may affect healthcare systems and accountable care organizations. Informs the employee population regarding these compliance matters through personal initiatives, seminars, training programs, and peer contact. Assisting organization leadership team in program planning and development of Business Plans. Provides analysis of business plans and budget as requested. Creating a self-development plan to improve leader skills, competence, and outcomes. Serves as organization's Privacy Officer.
Qualification and Experience
Qualification Requirements: A Bachelor’s degree; Master’s degree in healthcare related field preferred. Law degree is strongly preferred. 5+ years’ 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.
Requisition #: 32935.
Eastern Maine Healthcare Systems
43 Whiting Hill Road
Brewer, ME 04412