SWHRCIN VP Chf Rsk & Cmpl Off SWHR CIN

The VP Compliance Officer has the following duties and responsibilities:

• Develops initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent, detect, and correct illegal, unethical, or improper conduct.
• Develops strategic plan for compliance, privacy and risk programs and manages day-to-day operations and metrics of the compliance teams to support it.
• Develops and routinely reviews and updates, as necessary, the Compliance Plan and Code of Conduct to ensure continuing currency and relevance in providing compliance guidance to management and employees.
• Acts as an independent review and evaluation body to ensure that compliance issues / concerns within the organization are being appropriately evaluated, investigated and resolved. Collaborates with other departments (e.g. Risk Management, HR, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with internal and external counsel, as needed, to resolve difficult legal compliance issues.
• Oversees compliance requirements related to delegation oversight including First Tier, Downstream, and Related (FDR) entities and independent contractors.
• Manages the special investigations unit (SIU) and other compliance investigations; responds to alleged violation of rules, regulations, policies, procedures and Standard of Conduct by evaluating or recommending the initiation of investigative procedures; develops and oversees a system for uniform handling of such violations; monitors, and as necessary, oversees compliance activities of other departments to remain abreast of status of compliance activities.
• Performs and/or oversees annual compliance risk assessment to identify organizational risks.  Based on the results of the risk assessment, works with leadership on creation of risk profile, metrics, workplan and corrective actions.
• Provides reporting on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee, Compliance and Audit Committee of the Board, Board of Trustees and senior management informed of the operation and progress of compliance efforts.
• Monitors key performance and risk indicators/metrics to assist with early identification of risk trends across various operational units.
• Institutes and maintains an effective compliance communication program for the organization, including promoting use of the Compliance Hotline and retaliation-free reporting; promotes awareness of Code of Conduct and understanding of new and existing compliance issues and related polices/procedures.
• Partners with Human Resources and others as appropriate to develop an effective compliance training program for newly hired employees and annual refresher training for existing employees.
• Oversees coordination of external compliance audits from entities providing oversight, including but not limited to Contracted Payors, State Departments of Insurance, and CMS.

Individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  This role requires the ability to solve problems, think outside-the-box, and be resourceful; must be result-oriented, a quick learner, collaborative, respectful, an effective communicator, and a self-starter.  The requirements listed below are representative of the knowledge, skill, and/or ability required to build Southwestern Health Resources’ culture for action.

Education and/or Experience:

• Bachelor’s Degree in healthcare or business-related field required.
• Master’s Degree in healthcare or business-related field preferred.
• Minimum 10 years Management experience in healthcare, compliance or equivalent field required.
• Thorough knowledge of state and federal guidelines, accreditation bodies, participating provider agreements, HIPAA and Third-Party Administration (TPA) laws, credentialing regulation and prompt pay laws.
• Familiarity with operational, financial, analytics, quality assurance, audit and human resource procedures and Medicare Advantage regulations.
• Thorough understanding of the elements of an effective compliance program.