The Healthcare Compliance Officer will be responsible for overseeing the effective implementation and management of an organization's compliance programs. Reporting directly to senior leadership, this role ensures adherence to healthcare regulations, industry standards, and organizational policies. The Compliance Officer will be a subject matter expert, responsible for establishing compliance standards, monitoring internal procedures, and guiding teams on regulatory matters, including HIPAA Privacy and Security requirements.
Key Responsibilities:
- Develop and implement a comprehensive compliance program that meets regulatory requirements and is tailored to the organization's unique needs.
- Provide strategic direction to leadership on regulatory compliance issues and ensure alignment with organizational goals.
- Regularly review and update the annual compliance work plan to address evolving regulations and internal needs.
- Oversee HIPAA Privacy and Security program implementation and ensure compliance with all relevant regulations.
- Lead compliance and information security teams, fostering a professional and productive environment.
- Conduct internal audits, reviews, and monitoring activities to ensure ongoing compliance with applicable laws and internal policies.
- Provide training and education programs to promote understanding of compliance requirements across all levels of the organization.
- Develop and maintain policies that encourage the reporting of noncompliance or potential fraud, ensuring protection from retaliation.
- Prepare and present compliance reports to senior leadership and board committees.
- Act as the primary point of contact with external regulators regarding compliance matters.
- Coordinate and manage internal and external audits, reviews, and examinations, ensuring accurate and timely reporting.
- Conduct independent investigations into compliance issues and manage investigations originating from the compliance hotline.
- Ensure alignment with Medicare and Medicaid regulations, especially for organizations acting as business associates, and maintain client compliance with government program requirements.
- Review and approve policies and procedures for compliance with applicable regulations before submission to external parties.
- Evaluate the effectiveness of the compliance program on an ongoing basis, recommending improvements as necessary.
- Collaborate with internal teams, including Information Security, to ensure a unified approach to compliance and security.
- Provide guidance on fraud, waste, and abuse prevention, claims handling, and payment operations.
- Other duties as assigned.
Qualifications:
- Bachelor’s Degree required
- Minimum of 5 years of experience in a leadership role within healthcare compliance, particularly for entities acting as business associates.
- Strong knowledge of healthcare laws, regulations, and compliance practices, including HIPAA and Medicare/Medicaid.
- Experience with software programming, information security, and software security is highly desirable.
- Relevant certifications, such as Healthcare Compliance (CHC) or HIPAA Privacy (CHPC), are strongly preferred.
- Proficiency in MS-Office, Visio, MS-Project, and Adobe Acrobat, with experience using compliance software tools a plus.
Key Competencies:
- Effective Communication: Skilled at conveying complex compliance issues clearly across all levels of the organization.
- Resilience: Maintains composure and professionalism in high-pressure situations, demonstrating a positive attitude and adaptability.
- Problem-Solving: Capable of making sense of complex information, managing multiple projects, and addressing regulatory challenges with well-organized solutions.
- Accountability: Ensures commitments are met and holds others to the same standard, fostering a culture of responsibility and compliance.
