Foster the ongoing development and maturation of the Compliance Program to promote a culture of ethical and compliant behavior in accordance with laws and regulatory requirements and ensure internal controls and compliance that adapt to changes in laws, regulations and business products. Develop, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
Manage day-to-day operation of the Compliance Program. Collaborate with other departments (e.g., Finance, IT, Security, Human Resources, Operations) to direct compliance issues to appropriate existing channels for investigation and resolution. Consult with the Legal Department as needed to resolve legal compliance issues.
Respond to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Oversee system for uniform handling of such violations. Manage internal reporting process, including an anonymous telephone/online reporting system. Maintain an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. Work with the Human Resources Department and others, as appropriate, to ensure an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.
Compliance Activity Monitoring
Monitor, and as necessary, coordinate compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends. Identify potential areas of compliance vulnerability and risk, and develop/implement corrective action plans for resolution of problematic issues. Provide general guidance on how to avoid or deal with similar situations in the future. Monitor the performance of the Compliance Program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness.
Provide reports on a regular basis to the VP, Compliance and Privacy, and as directed or requested, to management and the Board of Directors, to keep such parties informed of the operation and progress of compliance efforts.
Critical Success Factors
Business Knowledge/Intelligence. Demonstrates a thorough understanding of the roles, relationships and systems across the organization and the desire to improve processes to the advantage of customers and the organization. Knowledgeable about how organizations function; knows how to get things done both through formal channels and the informal network. Demonstrates ability to deal with complex challenges and offers creative solutions. Demonstrates consistent intellectual sharpness, agility and capability. Quick learner.
Customer Focus. Demonstrated ability to effectively work with clients, customers, and business partners to accurately assess needs, provide information or assistance, resolve problems, or satisfy requirements; demonstrated knowledge of and interest in the Company’s business, products and customers and commitment to providing exceptional service and support to customers and colleagues.
Drives for Results and Growth. Serves the whole business. Works with urgency. Achieves strategic, operational, and financial goals. Pushes for quality improvements. Takes advantage of market opportunities. Champions new tools and processes and works with internal partners to link market needs to new offerings. Delivers measurable results.
Identifies and Develops Talent. Surrounds self with highly capable people; builds a team. Empowers people through coaching and mentoring. Recognizes and rewards others’ contributions. Develops bench strength. Develops leadership in others through coaching, mentoring, rewarding, and guiding employees.
Individual Effectiveness. Demonstrates consistency in development and enhancement of personal business skills and habits needed to communicate effectively and honestly, manage time and stress, and attract others to well-reasoned and logical points of view. Deals calmly and effectively with high stress situations, such as tight deadlines or hostile individuals. Uses time effectively, properly assessing and utilizing priorities in time allocation; controls distractions that waste time and break work flow. Makes sound, well-informed, and objective decisions; perceives the impact and implications of these decisions; commits to action, even in uncertain situations, that support accomplishment of organizational goals.
Performance. Understands the goals of the organization and sets and achieves ambitious goals that are consistent with the goals of the organization. Understands company policies and works within them to achieve customer satisfaction. Can be counted on to exceed goals successfully; is constantly and consistently one of the top performers in the organization; bottom line oriented and strategically focused; steadfastly pushes self and others for results.
Problem Solving. Enjoys the challenge of a difficult problem and demonstrates ability to solve a variety of problems with effective solutions; asks good questions to isolate problems and probes all fruitful sources for answers; can look beyond the obvious and does not stop at the first answer. Knows when to solve problems on own and when to consult others for support. Can differentiate a small problem from a large one and take appropriate action. Does not get sidetracked by trivial details. Identifies problems; determines accuracy and relevancy of information; uses sound judgment to generate and evaluate alternatives and make recommendations.
Resourcefulness and Flexibility. Open to change and new information; adapts behavior and work methods in response to new information, changing conditions, or unexpected obstacles; adjusts rapidly to new situations warranting attention and resolution; Self-managed and self-motivated. Can identify what needs to be done and does it. Demonstrates appropriate good judgment in balancing customer needs with business needs. Seeks opportunities to expand responsibilities within the context of the job and to help out others. Demonstrates frustration tolerance. Maintains composure and professionalism when faced with unexpected problems or difficult situations.
Teamwork/Leadership. Contributes to creating and maintaining an environment of cooperation, pride, trust and group identity; demonstrates an understanding of broad team goals and works effectively with others to achieve goals; contributes positively to an open exchange of ideas and an atmosphere of collaboration.
Education; Certifications and Licensures
Minimum BS/BA in a related field of study. Preferred: JD, MBA/MHA, or other appropriate advanced degree.
CHC required; CHPC preferred.
Minimum seven (7) years of experience in compliance administration within a healthcare-related organization, to include demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must. Must have experience with Medicare Advantage and Medicaid compliance programs; experience with HIPAA compliance programs a plus.
Bachelors or better.