Responsible for developing, implementing and overseeing an effective compliance program within the Pueblo of Jemez Health and Human Services including health information privacy and security, Title V compact and grants, Accreditation Association of Ambulatory Health Care (AAAHC) and Federally Qualified Health Centers (FQHC) standards, statutes and regulations.
• Establishes and ensures an effective compliance program operates within JHHS including health information privacy and security, Title V compact and grants, Accreditation Association of Ambulatory Health Care (AAAHC) and Federally Qualified Health Centers (FQHC) standards, statutes and regulations.
• Manages the day-to-day operation of the compliance program.
• Functions as an independent and objective body reviewing and evaluating compliance issues and concerns within the department; ensures the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies, POJ policies and procedures are being followed, and, behavior in the department meets the POJ standards of conduct.
• Monitors and reports results of the compliance and ethics efforts of the JHHS and provides guidance for the Health Board, Director and senior management team on matters relating to reporting and compliance.
• Develops, initiates, maintains and revises policies and procedures for the general operation of the compliance program and its related activities, linked to the OIG seven elements of an effective compliance program, to prevent illegal, unethical or improper conduct.
• Identifies new risks and projects through various methods including regular meetings with JHHS leadership, legal, and external sources; and collaborates with directors and managers to improve processes, implement controls and compliance solutions.
• Provides compliance training to new hires; follows up with continued effective online compliance training; informs leadership on compliance policies; and conducts compliance committee updates.
• Authorized to implement all necessary actions to ensure achievement of the objectives of an effective compliance program.
• Manages Compliance Officer initiated investigations of alleged violations of law, standards of conduct, or violations of compliance policies and procedures and standards of conduct; interviews/fact findings and analysis; presents
recommendations to leadership; and, remediates the root cause via process improvement and control development.
• Develops audits to assure that corrective action plan steps were implemented and successful.
• Establishes a standard reporting mechanism which includes the findings as well as the corrective action plans.
• Develops a tracking mechanism for regular monitoring of transactions to allow for reporting of improvement and effectiveness of the compliance program.
• Develops and implements a code of conduct that includes but is not limited to, elements which support the compliance plan.
• Conducts periodic reviews to assess adherence to compliance plan and addresses issues/problems identified in an audit assessment.
• Develops and implements a compliance feedback/prevention process to ensure that results of audits, investigations and compliance office recommendations are evaluated and, if appropriate, integrated into new or existing policies procedures, processes and education and training.
• Develops projects and proposals to educate the healthcare community concerning requirements related to the privacy and security of individually identifiable health information.
• Prepares reports, briefings, policy options, or other materials for use by JHHS managers and leadership.
• Contributes to the overall quality of the unit’s service provision by developing and coordinating work teams and by reviewing, recommending and implementing improved policies and procedures.
• Represents the Pueblo with dignity, integrity, and a spirit of cooperation in all relationships with staff and the public.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
Education and Experience: Bachelor’s Degree in business or public administration or a closely related field; AND three (3) years of progressively responsible analytical or administrative, or clinical managerial, or supervisory experience in the healthcare field.
Required Certificates, Licenses, and Registrations:
• Valid New Mexico Driver’s License.
• Missions, organizations, programs, and requirements of healthcare delivery.
• Regulations and standards of various regulatory and credentialing groups including federal fraud and abuse laws.
• Theories, principles, practices, and techniques of healthcare compliance including HIPAA and the Privacy Act
• AAAHC accreditation standards and FQHC requirements.
• Operational, financial, quality assurance, and human resources procedures and regulations.
• Planning, monitoring, and evaluating healthcare programs.
• Project management and analytical techniques.
• Data sampling and statistical analysis techniques.
• Internal and external audit processes and procedures.
• Budgetary practices and terminology.
• Computer applications related to the work.
• Techniques for dealing with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds, in person and over the telephone.
• Writing policy and procedures
• Managing and tracking all compliance activity in an organization.
• Complying with applicable laws, codes and regulations.
• Performing professional-level analytical and programmatic work.
• Carrying assigned projects through, from data gathering to completion.
• Using initiative and independent judgment within general policy guidelines.
• Using tact, discretion and prudence in dealing with those contacted in the course of the work.
• Managing investigations.
• Preparing clear and concise reports, correspondence and other written materials.
• Contributing effectively to the accomplishment of team or work unit goals, objectives and activities.
• Dealing successfully with a variety of individuals from various socio-economic, ethnic and cultural backgrounds, in person and over the telephone, often where relations may be confrontational or strained.
• Communicating effectively in oral and written forms.