Vice President/Chief Compliance Officer
Under the direction of the CEO and Board of Directors, the Vice President/Chief Compliance Officer will collaborate with the Executive Team, senior leadership team and external consultants as needed to implement and facilitate the organization’s Compliance Program.
The Vice President/Chief Compliance Officer is a key leadership role and is responsible for providing strategic and operational leadership pertaining to compliance and regulatory issues as well as oversight of the enterprise wide comprehensive compliance program that includes both Medi-Cal and Medicare Compliance Programs that meet and exceed the OIG’s compliance guidance components and elements of an effective program. The Vice President/Chief Compliance Officer also oversees the development of a compliance risk management program to assess, prioritize and manage regulatory and legal compliance risks based on state and federal guidelines and requirements through the systematic assessment and management of compliance risks.
The Vice President/Chief Compliance Officer is also responsible for enterprise-wide confidential reporting systems allowing employees, customers, contractors and other stakeholders to disclose violations of the corporation’s ethical standards, violations of law or corporate policy relating to such matters without fear of retaliation.
The Vice President/Chief Compliance Officer will ensure alignment with the mission, core values, policies and strategies of IEHP. The Vice President/Chief Compliance Officer will ensure accountability and compliance with applicable legal, governmental and regulatory requirements.
Duties and Responsibilities
The Vice President/Chief Compliance Officer is responsible for the overall strategic direction and implementation of the Compliance Program. Duties include, but are not limited to:
- Provides executive strategic leadership to Compliance operations including the development and distribution of written standards of conduct and policies and procedures that promote the organization’s commitment to compliance.
- Reviews the content and performance of the enterprise wide Compliance Program, including compliance policies, procedures and code of conduct on a routine basis and takes appropriate steps to ensure its effectiveness to prevent, detect and correct illegal, unethical or improper conduct with the organization.
- Develops, implements and presents regular compliance and risk management training and education to executive staff and the Board of Directors at least annually and as needed. Such training includes introductory compliance training, as well as ongoing training on compliance related topics as needed.
- Provides executive oversight and maintenance of the compliance hotline and processes to receive and resolve complaints and concerns; development and management of policies and processes to respond to allegation of improper or illegal activities; auditing and monitoring to ensure compliance with applicable regulations, policies and OIG elements of an effective compliance program.
- Establishes development and strategic oversight of processes to ensure non-employment/engagement of individuals or entities excluded from participation in federal health care programs (sanction checking).
- Ensures appropriate enterprise wide policy development, staff education, investigations of alleged regulatory and policy violations, compliance monitoring and auditing.
- Serves as the Chair for the Compliance Committee and serves in an advisory capacity to keep executive leadership and senior management informed on the operation and progress of the organization’s compliance efforts.
- Oversees the development, implementation and maintenance of an effective compliance communication by partnering with various departments such as Legal, Human Resources, Operations and other departments as required.
- Provides real-time guidance to business unit leadership related to the translation of regulatory requirements and changes.
- Budgets, recruits, manages, develops and retains the necessary resources to successfully perform the Compliance function.
- Experience Requirements: Total experience should include a required minimum of 10 years of compliance experience in managed care with at least 5 years of senior management experience.
- Educational Background: Bachelor’s Degree in a work-related discipline from an accredited college or university. Master’s Degree, such as but not limited to MPH, MPA or MHA from an accredited institution required.
- Professional Certification: CHC on hire or within 6 months.
- Knowledge: Subject matter expertise level knowledge of federal and state health care compliance laws and regulations, OIG enforcement methods and other applicable federal and state compliance guidance, as well as industry best practices in compliance. Ability to understand, interpret and apply complex state and federal health care compliance laws, rules, regulations and guidelines; performs research analysis of health care laws, regulations and policies. Extensive knowledge of Medi-Cal and Medicare rules and regulations, and managed care in California. Demonstrated understanding and sensitivity to diverse and multi-cultural environment and community.
- Skills: Excellent writing, interpersonal communication and organizational skills in a variety of situations. Proficient with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) to effectively track and manage deliverables. Demonstrated ability to develop and deliver comprehensive compliance training and education to all levels of staff, including members of the Board of Directors.
- Abilities: Ability to understand, interpret and apply complex state and federal healthcare compliance laws, rules, regulations and guidelines; performs research and analysis of healthcare laws, regulations and policies. Develops high levels of credibility and accountability. Leads by influence with transparency and develops direct reports. Ability to establish and maintain collaborative, credible, trusting partnerships with individuals across a broad range of people and groups, both internal and external. Works well under pressure, producing high quality results.
- Commitment to Team Culture: The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
- Other: Must have a valid California Driver’s license.
- Privacy: IEHP Team Members are expected to ensure the privacy and security of PHI (Protected Health Information) as outlined in IEHP’s policies and procedures related to HIPAA compliance.
- Working Conditions: General office environment; word processing and data entry involving computer keyboard, mouse and screens; automobile travel within California.