Director, US Healthcare Compliance
Job Code : GEN/1199
Work@HomeJob Description
The Director of US Healthcare Compliance
is responsible for ensuring regulatory, statutory, and contract compliance of the
Company?s Healthcare Operations (Provider and Payor) in the United States and
working in concert with the healthcare compliance and information security teams
in Jamaica, India, Philippines and Colombia to ensure regulatory, statutory and
contractual compliance. More specifically to ensure the Federal and State Healthcare
compliances specified by the Department of Health and Human Services (HHS), HIPAA
1996 and Security/Privacy Rules, HITECH Act 2009 and other healthcare related
guidelines, Centers for Medicare & Medicaid Services (CMS), Medicaid Guidelines,
Compliance requirements specified by the Office of Inspector General (OIG), General
Services Administration (GSA), Office of Foreign Assets Control (OFAC), and licensing
provisions for TPA and agent under Insurance Codes specified by the respective
State?s Department of Insurance. The Director of US Healthcare Compliance
oversees the management of the Corporate Compliance Program, functioning as an
independent and objective body that reviews and evaluates compliance issues and
concerns within the organization. The individual selected for this position
will report directly to the EVP, Global General Counsel and will be responsible
for reporting incidents of compliance and ethics to the Group CEO and Board of
Directors and to ensure all organizational operations, reporting systems and
documentation comply with regulatory requirements. The Director of US Healthcare
Compliance will not, directly or indirectly, engage or participate in any outside
activity that would, or may be perceived to, conflict with the best interests
of the Company or his/her duties to the Company.
Duties and Responsibilities:
1.
Develop, initiate, maintain, and revise policies and procedures
for the general operation of the Compliance Program to meet contractual,
statutory and regulatory requirements and maintain and update, as necessary and
appropriate, the World Class Compliance Program (WCCP) charter document(s).
2. In collaboration
with the Senior Manager for Healthcare Security and Compliance, develop and
deliver timely and appropriate compliance trainings for all employees,
temporary staff, executives and delegated entities (vendors) at the time of hiring
or contracting and annually thereafter. The trainings should emphasize the Company?s
commitment to comply with its Code of Conduct; HIPAA Privacy; HIPAA Security;
Fraud, Waste and Abuse (FWA); and the WCCP.
3.
Chair and/or participate in various Committees of the organization,
including the Quality Committee and Compliance Committees for each of the
healthcare operating entities.
4.
Manage, organize and maintain compliance records (includes TPA
registrations, Agent Licenses, process review reports, logs, records related to
compliance committee meetings and other records as required by law) for a duration
specified by applicable regulations and client contracts.
5.
Review and analyze documents submitted by other staff for
compliance, provide guidance as needed to ensure the organization?s contractual
obligations are met. Compile and report
compliance related data or informational requests as necessary to relevant
stakeholders and clients.
6.
In collaboration with the Senior Manager for Healthcare Security
and Compliance, develop, implement and oversee an effective vendor oversight
program to ensure each delegated entity (vendor) is meeting the organization?s
contractual obligations with its clients, its SLA with the vendor, and other
regulatory requirements.
7.
Investigate reported events, incidents, facilitate with internal
departments in remediating the compliance FWA issues or incidents.
8.
Coordinate with SPOCs and operational departments and actively
participate in client pre-delegation audits, compliance program audits, compliance
assessments, quarterly or annual compliance attestations and other ongoing monitoring
activities related to compliance and FWA.
9.
Coordinate with Human Resources and Procurement departments to
ensure all new hires are screened against the OIG/GSA Exclusion List prior to
hire and monthly thereafter. This includes employees, temporary staff,
consultants, executives, delegated entities (vendors) and the governing body.
10. Establish and
maintain clear consistent and an effective communication related to compliance and
FWA with all levels of staff, including, but not limited to updated compliance
posters at all office locations and intranet updates in coordination with Human
Resources, Legal, Information Security, and Corporate Communications
departments.
11. Review and
revise client contracts related to clients? compliance expectations and
Business Associate Agreements (BAA).
12. Prepare and
execute quarterly Compliance Reports for the Board of Directors
on the effectiveness of the compliance programs and practices and provide
direct reporting of compliance issues or incidents that rise to the level of discretionary
or mandatory reporting to the Group CEO or Board of Directors.
13. Perform other
duties as assigned.
QUALIFICATIONS:
Education:
B.A. or B.S. preferably in a healthcare related field or
applicable healthcare compliance related experience.
Graduate degree in a healthcare related discipline is an advantage.
Possessing, actively pursuing or a commitment to pursue HCCA
certifications is an advantage.
Knowledge
& skills:
- Comprehensive understanding of Medicare,
Medicaid and Commercial Healthcare regulatory system and requirements.
- General understanding of computing
networks and application systems.
- General understanding of incident
investigation related to non-compliance and fraud, waste and abuse (FWA).
- Develop respectful and collaborative relationships
across all lines of the Company and its affiliates. Demonstrate tact and
discretion, especially when dealing with confidential and sensitive
matters.
- Excellent verbal and written
communication skills, exercise excellent judgment in handling confidential
and sensitive matters. Ability to write and edit communications for
maximum effectiveness with specific audiences.
- Patience, calmness and determination as
an effective and efficient problem solver to find solutions to complex
issues across numerous verticals, in multiple geographies, in an
organization with a complicated reporting and operational matrix.
REPORTING RELATIONSHIPS:
Directly reports to the Global General Counsel, with a dotted line
reporting relationship to the Sagility Board of Directors, Group CEO, and SVP,
Clinical Operations.
EXPERIENCE:
5-7 years healthcare compliance related experience.