PACE Compliance Officer
Employment Type: Full-Time
Position Summary: Under the direct supervision of the Neighborhood Healthcare Director of Compliance and Government Relations, and technical supervision by the PACE Director, the PACE Compliance Officer is responsible for developing, implementing and evaluating all day-to-day operations of the NHC PACE compliance program to satisfy 42 CFR 460.63 and 42 CFR 423.50 et. Seq. The PACE Compliance Officer will administer the program by implementing systems and processes designed to ensure compliance with applicable laws, regulation and standards and provide ongoing oversight of the compliance system, including making periodic reports to the PACE Compliance committee.
Essential Functions of the Job:
* Participates as a member of the NHC PACE Management Team.
* In collaboration with NHC Compliance Program, designs, organizes, implements and oversees the PACE Compliance Program;
* Maintain and support a culture of compliance, ethics, and integrity.
* Maintain knowledge of policies and procedures that are in accordance with applicable regulatory and legal requirements, and accreditation standards.
* Provides oversight and direction for development, revision management, and implementation of PACE Compliance policies and procedures.
* Serves as the PACE HIPAA Privacy Officer, and as such, provides leadership in developing, updating, and complying with compliance policies and procedures and regulations related to patient privacy and protected health information.
* Assures compliance with all State and Federal regulations regarding PACE services. Regularly checks the CMS website for relevant new or revised guidance materials, and makes recommendations to the PACE Compliance committee for incorporating new or revised guidance into the Compliance Program.
* Ensures annual risk assessments are completed and priority risks are identified in an annual monitoring and auditing work plan that is approved by the PACE Compliance Committee;
* Organizes and serves as project lead for audits by regulatory agencies. Coordinates audit preparation with NHC Director of Compliance.
* Develops and implements corrective action plans. Monitors and measures compliance issues including Fraud, Waste, and Abuse (FWA) issues. Receives and documents reports of conflict of interest and non-compliance. Ensures timely submission and communication with regulatory agencies regarding audits.
* Develops and implements training programs regarding the PACE Organization's Compliance Program and ensures staff receives annual trainings including, but not limited to: infection control standards, OSHA, HIPAA, Fraud, Waste and Abuse. Implements necessary training for contractors.
* Ensures OIG and SAM exclusion lists, CMS's preclusion list, state nurse aide registry, Medicare opt-out list, and state-required exclusion lists have been checked monthly with respect to all employees, governing body members, and contractors as applicable. Coordinates results with Human Resources, Security, Legal or other departments as appropriate.
* Works with the appropriate departments and contracted providers to ensure licensing and certification requirements are kept up to date.
* Develop and maintain compliance reporting mechanisms that are accessible and confidential and that allow employees and contractors (including First Tier, Downstream or Related Entities ('FDRs') ) to report suspected fraud, waste, and abuse and other non-compliance on an anonymous basis and without fear of retaliation;
* Ensures the resolution of any potential or actual instance of noncompliance, assisting the Director of Compliance and Government Relations with administering the Compliance Hotline (phone + online) and coordinate responses to concerns submitted.
* Responsible for ensuring timely reporting to regulatory bodies as required under state and federal laws and regulations, including unusual occurrences and sentinel event reporting.
* Ensures instances of fraud or other misconduct are reported to the appropriate NBI MEDIC, CMS, and/or the State Administering Agency and other state-specific entities as required.
* Develops and maintains effective lines of communication between the NHC Director of Compliance and members of the Compliance Committee, senior leadership, and contractors. Receives regular reports on the results of auditing and monitoring activities and widely publicizes compliance policies and procedures throughout NHC PACE and its contractors.
* Reports on a periodic basis to the PACE Compliance committee and other senior management, regarding the activities and status of the PACE Compliance Program, including:
* the identification, investigation, and resolution of potential or actual instances of noncompliance;
* the results of auditing and monitoring activities and risk assessments, including the effectiveness of the PACE Compliance Program; and any instances of government compliance investigation, compliance enforcement or compliance penalties such as Notices of Non-compliance (observations, CARs, ICARs), Warning Letters or more formal sanctions.
* Participates in National PACE Association compliance related activities.
Additional Duties and Responsibilities
* PACE Medical Records oversight.
* Other projects and duties as assigned.
Education Required: BS in health related field
Experience Required:3 to 5 or more years of relevant compliance experience is required with experience in Healthcare Quality Improvement or Healthcare Compliance.
Experience Preferred: Required/DESIRED knowledge and skills: Creative, detailed-oriented and organized. Excellent written and verbal communication, with specific ability to maintain accurate records. Ability to facilitate effective meetings. High ability to influence and drive action Excellent customer service. Project management. Auditing experience. Integrity and discretion Problem solving Root-cause analysis Data collection and analysis; knowledge of basic statistical principles. Establishing and maintaining effective working relationships with all stakeholders. Research and analysis - laws and regulations MS Office skills (e.g., MS-Word and Excel in particular) Ability to explain arcane and complex topics to stakeholders Ability to establish priorities, coordinate work activities, multi-task and work independently. Training and/or experience working with PACE, MA, MA-PD or PDP programs (or adult day health center settings) and training working with regulatory authorities. Experience in health-care or aging services compliance highly desirable plus 2 to 5 years of relevant management experience.
* CA valid driver's license and reliable transportation
* Proof of current vehicle insurance (if applicable)
Technical Knowledge and Skills
* Must possess the skills necessary to provide care for geriatric patients
* Must thrive in team environment, must possess good organizational and supervisory skills, ability to effectively handle difficult and unusual interpersonal situations.
* Meet a standardized set of competencies for the specific position description established by NHC PACE and approved by CMS.
Working Conditions and Physical Physical clearance for reaching, bending, stooping, crouching, kneeling and grasping; have full range of motion; ability to lift 50 lbs; need to lift and transfer participants; T.B. clearance; must maintain current First Aid and CPR.
* MUST BE ABLE TO CLEAR FINGERPRINTS THROUGH DOJ AND FBI IN ADDITION TO A DRUG SCREEN CLEARANCE.