Hope Network

About Hope Network

Overview: The Healthcare Compliance Officer is a key associate at Hope Network whose primary responsibilities include: The Healthcare Compliance Officer (HCO) oversees the organization’s health care compliance program to prevent illegal, unethical or improper conduct. The HCO reviews and evaluates corporate healthcare policies and procedures and responds to healthcare compliance issues and concerns within the organization. The position strives to ensure that the board of trustees, management, and employees are in compliance with federal and state healthcare laws and regulations, and accrediting agencies. The position exists: As a channel of communication to receive and direct healthcare compliance issues to appropriate resources for investigation and resolution. As an internal resource with which concerned parties may communicate at any time. Summary: ESSENTIAL FUNCTIONS AND RESPONSIBILITIES: This is not intended to be an exhaustive listing of job functions. This job description in no way states or implies that these are the only duties to be performed by this employee. The employee is required to follow any other instructions and to perform any other duties as assigned. 1. Regular and predictable attendance is an essential requirement of this position. 2. Develops, initiates, maintains, recommends, and revises policies and procedures for the general operation of the healthcare compliance program and its related activities to prevent illegal, unethical, or improper conduct. 3. Manages day-to-day operation of the healthcare compliance program, including billing integrity auditing. 4. Provides corporate guidance to and collaborates with Compliance personnel in service lines to accomplish the goals of the healthcare compliance program. 5. Develops, periodically reviews, and updates the Standards of Conduct to ensure they continue to remain current and relevant to provide guidance to management and employees. 6. Collaborates with other departments (for example, Human Resources, Information Technology, and Legal) to direct healthcare compliance issues to appropriate existing channels for investigation and resolution. 7. Consults with General Counsel as needed to resolve difficult legal healthcare compliance issues. 8. Responds to alleged violations of rules, regulations, policies, procedures and standards of conduct related to healthcare by evaluating or recommending the initiation of investigative procedures. 9. Develops and oversees a system for uniform handling of such violations and identifies violation trends. 10. Acts independently to assist in ensuring healthcare compliance issues and concerns within the organization are being appropriately evaluated, investigated, and resolved. 11. Monitors and coordinates healthcare compliance activities of subsidiary service lines. Ensures all service lines remain abreast of compliance activities. 12. Identifies potential areas of healthcare compliance vulnerability and risk, develops and implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future. 13. Provides reports on a regular basis and, as directed or requested, keeps the compliance committee and senior management informed of the operation and progress of healthcare compliance efforts. 14. Coordinates with senior management to ensure proper reporting of violations or potential violations to duly authorized enforcement agencies as required. 15. Assists with the performance of security risk assessments as required by the HITECH Act. 16. Manages compliance hotline account and distributes cases to appropriate parties for investigation and/or follow up. 17. Institutes and maintains an effective compliance communication program for the organization, including promoting a) use of the compliance hotline, b) heightened awareness of standards of conduct, and c) understanding of new and existing healthcare compliance issues and related policies and procedures. 18. Works with Human Resources and others as appropriate to develop an effective healthcare compliance training program, including appropriate introductory training for new employees and ongoing training for all employees and managers. 19. Monitors the performance of the compliance program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness. 20. Other duties and projects, as assigned or required. Requirements: Educational / Talent Requirements: 1. Bachelor’s degree, required. Educational background in healthcare and/or certification in healthcare compliance, preferred. 2. Strong command of federal and state regulations relating to healthcare compliance. 3. Understanding of the healthcare coding and reimbursement systems, familiarity with CARF certification helpful. Work Experience Requirements: 1. A minimum of 5 years of experience in a healthcare compliance field. 2. Experience in data analytics and presentation of data. 3. Demonstrated ability to work independently and exercise good judgment while also maintaining relationships to work collaboratively across an organization. 4. Demonstrated compliance leadership ability and familiarity with operational, financial, quality assurance, and human resources procedures.

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Company Type: Nonprofit

Company Size: 1001 - 5000

Revenue: 100 - 500 million (USD)

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