Risk and Compliance Manager

Southern Tier Community Health Center Network, Inc. dba Universal Primary Care

This job profile is not included in a recognized pathway.

Description

Responsible for overseeing all compliance and reporting of grants and regulatory bodies for the organization. Supports the risk management plan ensuring compliance and providing assistance to the team as needed. Assists in researching and application of grants for the organization.

This position acts as the company Corporate Compliance Officer and Risk Manager.

Tasks

Communicates with management regarding new and revised regulations and other changes to grant funding requirements and opportunities.
Work with management to develop and oversee control systems to prevent or deal with violations of legal guidelines and internal policies. Evaluate the efficiency of controls and improve them continuously.
Revise policy and procedures, reports, etc. periodically to identify hidden risks or non-conformity issues.
Prepare reports to fulfill the requirements of relevant governmental rules and regulations.
Advise management on carrying out policies related to healthcare compliance programs in accordance with federal and state regulations.
Maintain knowledge of regulatory compliance standards in relation to FQHC’s, HRSA, FTCA, NY and PA DOH, 340b program, etc.
Develop effective relationships and ensure communication with partners and other stakeholders, including but not limited to state agencies.
Support 340b drug discount program compliance by conducting regular audits, regular meetings with contracted entities and regular reporting requirements.
Acts as the organization Risk Manager:
- Coordinate and provide leadership for the organization’s risk management program
- Ensure completion and documentation of risk assessments on at least a quarterly basis, as part of the organization's overall risk management program
- Implement measures to mitigate identified risks
- Ensure risk management policy and procedures are uploaded into the online learning management system for review by all organizational employees
- Participate in formulating risk reduction strategies, policy and/or organizational changes through the organization, to address known and identified areas of high risk
- Assist in the annual FTCA Deeming Application completion and submission
- Work with the Chief Human Resources Officer (CHRO) and Director of Clinical Services to develop annual Training Plans for staff, to include identified risk areas
- Oversee management of all internal Incident Reports, including investigating, facilitating root cause analysis (when needed), assisting with development and implementation of action plans, and closing the loop on resolution of incidents, with documentation being maintained of all activities
- Complete annual healthcare risk manager training
- Maintain awareness of other organizational functions that may sometimes relate to or impact risk management functions (e.g., compliance, credentialing and privileging, public relations, emergency management, and claims management)
Acts as the organization Compliance Officer:
- § Chair the Risk & Compliance Committee and serve as a spokesperson for the Committee.
  § Oversee and monitor the implementation of the Compliance Plan.
  § Report periodically to the Risk & Compliance Committee, the Chief Executive Officer, and the Board of Directors on the progress of implementation of compliance initiatives, corrective actions, and recommendations to reduce the vulnerability to allegations of fraud, waste, and abuse.
  § Develop and distribute all written compliance policies and procedures to all affected employees.
  § Periodically revise the program in light of changes in the needs of UPC and in the law; and changes in policies and procedures of government and private payer health plans and emerging threat vectors.
  § Develop, coordinate, and participate in a multifaceted educational and training program that focuses on the elements of the Compliance Plan and seeks to ensure that all employees are knowledgeable of, and comply with, pertinent federal, state, and private payer standards.
  § Ensure that employees, vendors, and Board of Directors do not appear on any of the Federal or State “excluded, debarred or suspended” listings published by Medicare and Medicaid.
  § Ensure that all Providers/Care Management Staff are informed of Compliance Plan standards with respect to coding, billing, documentation, and marketing, etc.
  § Assist in coordinating internal compliance review and monitoring activities, including annual or whenever necessary reviews of policies.
  § Review the results of compliance audits, including internal reviews of compliance, independent reviews and external compliance audits.
  § Independently investigate and act on matters related to compliance, including the flexibility to design and coordinate internal investigations.
  § Develop policies and programs that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation. (See Whistleblower Policy)
  § Interact with external legal counsel to discuss UPC’s initiatives on regulatory compliance.

Qualifications / Education

EDUCATION/EXPERIENCE

Associate’s degree in a related field is required.
Bachelor’s degree in a related field is preferred.
A minimum of five (5) years experience in healthcare is required.
Prior compliance and grant experience preferred.

SKILLS, ABILITIES, AND TRAITS

Must be able to multi-task
Basic Microsoft Office suite knowledge
Excellent verbal and written communication skills
Excellent organizational skills