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Organization TypePublic Interest
Years of Experience
Date Last Verified
ProfileArea Compliance Officer Description: Serves as the Hospital & Health Plan Compliance Officer, the Privacy Officer, & as a member of the Medical Center Leadership team. Responsible for the strategic development, Implementation & evaluation of compliance mgmt systems at the Medical Center, including contract hospitals, contract svcs, & other non-KFH facilities. Analyzes legal, regulatory, licensing & accreditation requirements & their impact on operations & oversees the development of compliance risk mitigation & corrective action plans. Ensures that controls are in place to guarantee privacy & security, to identify fraud, waste & abuse & to ensure that state & federal regulations are addressed. Collaborates w/ Medical Center leadership to ensure that operating procedures, systems & standards align w/ compliance requirements & controls & that staff is trained on these controls. Creates & manages detailed audits of Health Plan ad Hospital managed svcs. Develops strong collaborative leadership relationships w/ TPMG, external regulatory agencies & accreditation bodies, & uses these relationships to manage risks & establish priorities & plans to address these risks. Supports the Principles of Responsibility by maintaining the privacy & confidentiality of information, protecting the assets of the organization, acting w/ ethics & integrity, reporting non-compliance, & adhering to applicable federal, state & local laws & regulations, accreditation & licensure requirements. Ensures that the Medical Center has systems in place to achieve compliance by development of compliance mgmt systems (such as training, policies, procedures, monitoring & auditing, among others) across all functions. Assists managers to adopt a culture of compliance in their daily operations. Oversees the development, implementation & evaluation of corrective action plans & responses to internally & externally identified compliance issues. Creates & manages detailed on site audits of Health Plan & Hospital managed svcs. Co-leads the Medical Center Compliance Committee w/ TPMG partner & provides direction in establishing legislative & regulatory compliance strategy. Develops an audit plan & dashboard to communicate completion of corrective actions to senior leadership. Serves as the Privacy Officer & oversees systems to ensure the protection & security of member & patient health information. Ensures the integrity of the regional hotline process & conducts investigations to resolve compliance issues & complaints. In conjunction w/ Medical Center & Regional leaders, ensures that medical center service delivery changes meet requirements of state & federal regulators as well as billing requirements of Medicare & other federal coverage guidelines. Oversees medical center responses to external regulatory agencies such as CMS & the Federal Office of Civil Rights. Ensures that externally reported data adheres to federal & state rules. Manages identified privacy breaches to ensure that all reports are filed, root cause analysis is performed & that controls are initiated to prevent further loss of protected health information. Partners w/ the AFO in the development of a Fraud Waste & Abuse program that ensures internal controls are capable of preventing & detecting significant instances or patterns of illegal, unethical or improper conduct. Partners w/ the Support svcs Asst Administration on environmental health & safety programs & ensures that the environment of care provided is safe, functional, supportive & effective for the delivery of patient care & safety.
Qualification and Experience
Qualifications: Bachelor's degree in health care administration, business or public health administration, operations research, nursing, economics or other related field required, OR 4 years of experience in a directly related field. High School Diploma/GED required. If does not have the CHC, then must complete within 12 calendar months of hire. Experience in revenue cycle program development and strategic planning required. Demonstrate knowledge of accreditation and licensing requirements including: The Joint Commission, NCQA, Knox Keene Act, CMS, Cal-OSHA, HIPAA, MEDI-Cal regulations and standards. Demonstrate skill collaborating with multiple groups to achieve change. Demonstrate ability to balance priorities and manage risks. Able to influence Senior Leadership. Must be able to work in a Labor/Management Partnership environment. Preferred: Master's degree in business, health care, public administration, JD Degree or related field preferred. Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred.
Job Number: 645042
1600 Eureka Rd
Roseville, CA 95661