Director of Compliance

Compliance Oakland, California


Description

 

The Position: The Director of Compliance will lead the Compliance Department working cross functionally ensuring CEI is compliant with regulatory, licensing, and contractual requirements of Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), and other regulatory agencies. This requires a broad knowledge and oversight of internal and external provider compliance and program development. This position reports directly to the CEO and CFO.

Duties and Responsibilities

  • Oversight of the Compliance Program Manager in the administration of the Compliance Program.
  • Leads Policy Review Committee and oversight of the organizations development and implementation of policies and procedures.
  • Leads Compliance Committee including the development and successful completion of the committee’s annual work plan, Risk Assessment, reporting, and other related projects.
  • Draft/negotiate BAAs, data processing agreements and data provisions.
  • Assesses risks, identifies trends, and develops annual compliance work plan.
  • Institutes and maintains an active compliance communication program, including the Compliance Hotline and heightened awareness of the Code of Conduct.
  • Conducts compliance/fraud, waste and abuse investigations as necessary.
  • Oversight and monitors compliance including: Licensing, CAPs, the Fraud, Waste, and Abuse (FWA) program, and Grievance and Appeals.
  • Assures compliance with all State and Federal regulations regarding PACE services.
  • Investigate and document alleged violations of laws, regulations, policies, and procedures
  • Company liaison with CMS, DHCS, and other regulatory agencies regarding regulatory policy.
  • Leads organization in preparation for CMS, DHCS and other regulatory agencies’ site visits regarding PACE audits and opening of new site locations.
  • Develops cross-departmental work plans for external regulatory audits. Manages the collection, review, and quality check of deliverables.
  • Coordinates with internal departments in developing corrective action plans in response to audit deficiencies and monitors status.
  • Fosters and maintains collaborative relationships within the leadership and management and with external agencies related to peer review, accreditation, and regulatory requirements.
  • Maintain a current working knowledge of regulations and regulatory changes relevant to CEI and the PACE model.

In addition to the Duties and Responsibilities outlined above, this position is expected Perform other duties as assigned in a positive and helpful manner

Requirements

Qualifications

  • Bachelor’s degree required; master’s degree preferred in Public Health, Nursing, Healthcare Administration or related field strongly preferred.
  • Certification in Healthcare Compliance (CHC) and HIPAA Privacy Certification (CHCP) is a plus
  • 10 years of progressive experience in healthcare compliance.
  • Experience interpreting, implementing and monitoring regulatory requirements and/or guidelines from CMS and DHCS required.
  • Experience working with regulatory agencies.
  • PACE program experience highly desirable.
  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information
  • Excellent leadership, strategy, management, and organizational skills.
  • Ability to read, analyze, and provide sound interpretation of rules, regulations, and guidelines.                                                                                                                                     

The above job description is intended to communicate the general function of the mentioned position and by no means shall be considered an exhaustive or complete outline of the specific tasks and functions that will be required.  CEI reserves the right to change job descriptions, site assignments, and or work hours as required by the needs of the program.  All employees are expected to perform their duties within their ability as required by the job and/or as requested by management. 

 

 

 

 

 

Center for Elders’ Independence is a PACE (Program of All- Inclusive Care for the Elderly) organization that uses an interdisciplinary team approach to care planning and care implementation for the purpose of providing high quality, affordable, integrated health care services to the elderly, including an Adult Day Health Center, and promoting autonomy, quality of life and the ability of individuals to live in their communities. Unlike other healthcare plans, CEI is not a "fee-for-service" plan. It is a “capitation” healthcare plan. CEI is paid a set amount for each person enrolled in our program, whether or not that individual seeks care. We are a growing company that offers stability and continues to thrive.