POSITION: Chief Compliance and Risk Management Officer
POSITION SUMMARY: Position will work closely with and have liaison reporting to the Vice President, Medical Director. Annually and more regularly as needed the incumbent will report to the Board of Trustees and its President on compliance and risk management activities, findings and concerns. The position serves as the focal point for compliance and risk management activities and needs to be a person of high integrity and, as the Chief Compliance & Risk Management Officer, will have the authority to exercise independent judgment without fear of reprisal. The incumbent will have direct access to organizational leadership and legal counsel. In exercise of duties, the incumbent will have authority to review all documents and records related to compliance including contracts and arrangements with other parties, medical charts, billing forms, human resource files, complaints, legal cases and suits, research data, and marketing materials. The incumbent will have the authority to stop processing of medical claims or contractual arrangements if it is believed to be legally problematic and until resolved. The incumbent will have extended responsibilities to guide, oversee or collaborate with individuals and programs in: HIPAA privacy and security, safety and OSHA, EEOC and labor, and liability defense counsel. The incumbent will oversee insurance policy matters and renewals and ensure areas of organizational risk are identified, managed, and insured as may be appropriate.
POSITIONS SUPERVISED: None directly, although matrix management and responsibility exists for designated individuals with program responsibility in HIPAA, OSHA, etc.
ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES:
a. Identifies functions and business and clinical practices requiring compliance and risk management related activities and prioritizes attention thereto;
b. Designs, implements and monitors a Compliance Plan and related policies, procedures, and reporting mechanisms;
c. Reviews and manages all aspects of Clinic liability insurance coverages and insurance policies and their regular renewal. Manages the expenses related to liability insurance premiums and investigative work. Ensures areas of risk are adequately identified and insured, and designs and implements internal programs designed to mitigate risk and enhance safety.
d. Promotion of safe and high quality medical care and compliance with regulatory requirements. Promotes an organizational culture of awareness, responsibility, self-policing, and collaboration in ensuring that behavior is consistent with Clinic codes of conduct, and promotes a culture where reporting of potential problems is confidential, safe, and expected.
e. Provides guidance to individuals with accountability for implementation of policies and procedures related to compliance and risk management. This would include Privacy Officer, Security Officer, OSHA and Safety Officer, Medical Director, Director, Business Office, Senior Director, Human resources, and other members of the management, staff and physician teams;
f. Participates with and serves as staff to Compliance Committee, Quality Improvement/Peer Review Committee and coordinates all elements of Quantros Risk Management and Error Reporting software system.
g. Independently identifies or responds to reports of compliance concerns, errors or risk. Independently investigates or may coordinate investigative parties in matters of compliance reports or concerns, internal audits, external audits or surveys, risk identification and error reporting, or legal suit due diligence. May recommend corrective or disciplinary action as indicated;
h. Reviews contracts, files and charts, business relationships and financial matters for risk management and compliance with legal and regulatory requirements;
i. Stays informed of federal and state regulatory matters. Communicates to organization as needed and adjusts compliance and risk programs and protocols as needed;
j. Develops, individually and collaboratively, education, training and communication programs for physicians, management and staff, and outside contractors, on elements and requirements of Clinic compliance policies procedures, and reporting mechanisms;
k. Reviews all incident reports and manages with external parties all suits, defense coordination and any relevant settlement discussions. Coordinates internal incident response directly or through management or staff. Within established parameters, is responsible for all settlement or expense coverage offers in response to incidents or claims;
l. Manages all parties involved in medical malpractice claims, and their investigation and discovery;
m. Regularly reports to organizational leadership and committees as may be organized, on the findings, conclusions, policies and procedures, and plans with respect to investigations, corrective actions, remediation programs, new legal or regulatory requirements, and plan or program modifications.
n. Assumes other duties and reporting obligations as may be necessary and consistent with functional expertise and organizational needs and priorities.
Bachelors degree required in area of related business or clinical field. Certification in Healthcare Compliance (CHC) and/or Risk Management (CPHRM) preferred.
Knowledge, Skills, and Abilities:
Prior experience in regulatory compliance or risk management, preferably in the health care field. Incumbent must possess excellent written and verbal communication skills, tact and diplomacy, resolve in the face of challenge, organization and multi-tasking capabilities, detail orientation yet ability to think big-picture. Intermediate to advanced computer, word processing, spreadsheet and database skills required. Individual must be equally adept at presenting to large groups and one-on-one, as well as dealing with individuals at all levels of an organization, both professionals and hourly staff.