Compliance Coordinator

POSITION SUMMARY: Responsible for implementing, and maintaining Medicare/Medi-cal, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) wide compliance and audit programs, policies and procedures that promotes a corporate culture that fosters ethical and compliant behavior and provides the basis for ensuring adequate internal controls and compliance with all laws and regulatory requirements applicable to Medicare, Medi-cal, and JCAHO.

REPORTS TO: Director of Compliance

QUALIFICATIONS:

Education: Bachelor’s degree is required. Master’s or Juris Doctorate degree is preferred Experience: A minimum of 2-4 years’ experience in a healthcare organization, to include

demonstrated leadership. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations is a must.

Core Competencies: Strong preference for at least two years of experience in healthcare compliance matters. The successful candidate will be recognized for demonstrated knowledge in compliance process improvement and the requirements of Federal healthcare programs. Clear, concise and persuasive writing and presentation skills. Strong organizational skills and an orientation to deadlines and detail. Ability to respond well under pressure. Skills in use of information systems, databases, Excel and Microsoft Word. Well-developed communication skills. Diligent about follow-through, thorough and well-prepared.

Other: Valid driver’s license and auto insurance.

FUNCTIONS AND RESPONSIBILITIES:

1. Implementing the organization’s, processes and policies designed to ensure compliance with Federal healthcare program requirements

2. Serve as a resource to leadership, employees and staff related to compliance requirements. Among the specific responsibilities and activities are the following:

a. Advise on issues concerning compliance and ethics matters including recommending controls designed to ensure compliance.

b. Work collaboratively with leadership in compliance and ethics program development and implementation.

c. Establish effective working relationships and build credibility within the organization to support a culture of ethics and compliance.

d. Interface directly with facility employees and serve as a sounding board for their concerns about ethics and compliance matters.

e. Manage the physician compliance with activity logs and visit note submission.

f. Work collaboratively with the Director of Compliance and other departments, if applicable, to investigate or supervise the investigation of compliance and ethics concerns about the organization that are raised through reporting mechanisms.

g. Oversee the implementation of the company’s education and training program that focuses on the requirements of the company’s compliance program to ensure that all directors, employees, contractors and physicians within the organization are knowledgeable of Federal healthcare program requirements and the requirements of the company’s Compliance program as required to perform their respective roles.

h. Ensure distribution of compliance and ethics policies and procedures and the company’s Code of Conduct.

i. Identify risk areas and assist in developing auditing, monitoring and oversight processes related to identified risks.

j. Oversee the implementation of corrective actions and monitoring in response to identified issues and audits and providing updates.

k. Develop monitoring systems and processes for compliance and ethics issues

l. Prepare monthly compliance reports identifying compliance issues.

m. Report to the Compliance Pre-Billing Manager on compliance matters on a routine basis

3. All reports shall be submitted to the Compliance Pre-Billing Manager and agency leadership every Friday of each month. The following is not an exhaustive list of reports:

a. Compliance pre-billing audit reporting and follow up with offices

b. OIG/SAMS/Medi-Cal Exclusion Check

c. External Credentialing

4. Monitor CMS, FI, MAC, state and local guidelines to determine changes to documentation and billing requirements.

5. Monitor and review annually the Conditions of Coverage and Conditions of Participation to determine changes to documentation and billing requirements in order to meet all requirements to continue to bill claims through the Medicare and Medicaid programs.

6. All other duties and responsibilities as assigned.