Compliance Officer

Position Description

COMPLIANCE OFFICER POSITION SUMMARY

The Compliance Officer is responsible for planning, designing, implementing and maintaining TRIHCI-wide compliance and audit programs; establishing policies and procedures designed to promote a corporate culture that foster ethical and compliant behavior and provide the basis for ensuring adequate internal controls and compliance with all laws, regulatory or contractual requirements applicable to TRIHCI, as well as TRIHCI's internal policies. The Compliance Officer reports directly to Chief Executive Officer/Principal Investigator and to the TRIHCI Board of Directors regarding compliance issues. In addition, He/she is responsible for assessing, monitoring and mitigating risks to the TRIHCI; oversight of compliance audits, conducting compliance investigations; implementing compliance education and training for employees; and maintaining the organization's compliance hotline. The Compliance Officer serves as a resource to TRIHCI staff and member health program staff on compliance related issues; upon request, may assist member programs with their compliance reviews. He/she serves as TRIHCI's HIPAA Privacy Officer. The Compliance Officer is authorized to implement all necessary actions to ensure the achievement of the objectives as outline in the Corporate Compliance Program.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Oversees, coordinates, and monitors compliance program and activities. If any misconduct or non-compliance is detected, recommend solutions and follow up to ensure that recommendations have been implemented. Develops and coordinates compliance training and education programs. Ensures conformance with applicable laws, statutes, regulations, and internal policies and controls. Coordinates resources to ensure the ongoing effectiveness of the Corporate Compliance Plan. Assures development of TRIHCI's Annual Compliance Work Plan. Reports on a regular basis to the TRIHCI Board of Directors. Independently investigates and acts on matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and any resulting corrective action. Responsible for compliance investigations relating to all departments, providers, agents and, if appropriate, independent contractors. Develops policies and programs that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation; Acts as TRIHCI's HIPAA Privacy Officer. Serves as resource to TRIHCI on healthcare laws, regulations, internal auditing procedures and standards including HIPAA. Monitors operation of the company's anonymous compliance hotline, including processing and complaints and/or reported violations, and determining how to address each call in a timely manner, including review and investigation, as appropriate; Assist TRIHCI departments with development of their compliance programs. Regular and predictable attendance. Other duties as assigned. Additional Responsibilities may include : Participation in all required staff meetings. Performing of duties or other related responsibilities as needed and assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed here are representative of the knowledge, skills, and/or abilities required. In accordance with the Americans with Disabilities Act (ADA), reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

KNOWLEDGE, SKILLS, AND ABILITIES

Must have knowledge of federal and state regulations related to health services, confidentiality, privacy regulations and fraud/abuse laws. Must have in depth knowledge of Office for Civil Rights regulations pertaining to HIPAA Privacy. Certified in Healthcare Compliance (CHC) through Health Care Compliance Association required. Certification in Healthcare Privacy and Security (CHPS) through the American Health Information Management Association (AHIMA) or Certification in Healthcare Privacy Compliance (CHPC) through the Health Care Compliance Association strongly preferred. Demonstrates skills in performing investigations, strong oral and written communication skills and high ethical standards. Expertise in use of Microsoft Word, Excel and Power Point. Ability to work well under pressure, work with multiple constituencies and communicate effectively is essential.

SUPERVISORY DUTIES

(IF ANY) Must have previous supervisory experience.

EDUCATION AND/OR EXPERIENCE

Master's degree in healthcare field preferred. Must have at least 3 years experience in leadership role in healthcare with a demonstrated understanding of all elements of an effective compliance program or Bachelor's degree in healthcare field. Must have at least 6 years experience in leadership role in healthcare with a demonstrated understanding of all elements of an effective compliance program.

CERTIFICATES, LICENSES, REGISTRATIONS

Must have a Valid California Driver License and be insurable with the Tule River Indian Health Center Inc. insurance agency.

PREFERRED QUALIFICATIONS AND CONTINGENCIES

TRIHCI maintains a drug and alcohol-free workplace, and all offers of employment are contingent on the successful completion of a criminal background check, a post-offer drug test and physical, and verification of the right to work in the United States. All candidates for the Compliance Officer position must have acceptable work history if previously employed with the Tule River Indian Health Center, Inc., Tule River Tribe and/or Tribal Entities. Preference in hiring is given to qualified American Indians in accordance with the Indian Preference Act (Title 25, US Code, Sections 472 & 473). Applicants claiming Indian Preference must submit Indian verification, certified by Tribe of affiliation or other acceptable documentation of Indian heritage.

Physical Work Environment :

The description provided here is representative of those conditions in which the Compliance Officer will be required to perform the essential functions of this position. As stated earlier, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position. While performing the duties of this position, the Compliance Officer is situated in a standard office environment within the health center, where there is little or no exposure to variations in the weather or other similar elements. The Compliance Officer will move throughout the health center to meet with supervisors and co-workers but maintains limited direct patient/client contact. Consequently, the Compliance Officer must: Possess the mobility to work in a standard office setting (i.e. walk, stand, or sit for extended periods of time); Possess the ability to use standard office equipment to write, type, copy, fax, or perform other duties; Possess the strength to lift and carry supplies weighing up to 10 lbs. repeatedly and up to 25 lbs. intermittently; Possess the visual acuity to read printed materials and a computer screen; and Demonstrate hearing and speech capabilities that allow him/her to communicate in person and over the telephone as required. The clinical setting at TRIHCI is categorized by OSHA as a Blood-borne Pathogen facility. Consequently, there exists the potential for exposure to blood, body fluid/tissue, and infectious wastes. There also exists the potential for exposure to chemicals, biologicals, and toxicants found on-site.