VP Compliance and Privacy Officer

at  Equality Health

POSITION SUMMARY:

Equality Health is an Arizona-based population healthcare company focused on improving care delivery for underserved populations through culturally-sensitive programs that improve access, quality, and patient trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. We have developed our product portfolio around centralized technology, services and network designs intended to organize a better healthcare delivery system for cultures that have struggled with integrating into the tradition one-size-fits-all U.S. healthcare system.
The Compliance and Privacy Officer will oversee the corporate compliance program that covers multiple lines of business across multiple states, and includes compliance with the rules and regulations of the Centers for Medicare and Medicaid Services, as well as state Medicaid agencies. Responsibilities include, but are not limited to, the development and standardization of policies and procedures for compliance, auditing and monitoring training and education, compliance related investigations, and reporting. The individual in this role will also be responsible for the day to day management and oversight of a team of compliance specialists.

REQUIRED KNOWLEDGE, EDUCATION & EXPERIENCE:

• Bachelor’s degree in a related field of study; or, an equivalent combination of education and/or experience
• Compliance Certification required
• Minimum of 10-15 years of healthcare compliance/regulatory experience in federal programs including Medicaid and Medicare
• Significant experience working with CMS, experience with CMMI preferred.
• Strong knowledge and understanding of how to develop, implement and manage healthcare compliance programs
• Background in Medicare and Medicaid reimbursement, fraud and abuse laws, and healthcare privacy laws
• Knowledge of federal and state laws and regulations
• Excellent verbal, written and interpersonal communication skills
• Strong organizational skills
• Demonstrated ability to handle highly sensitive and confidential information in compliance with Health Insurance Portability and Accountability Act (HIPAA), and company confidentiality policies and procedures

HIGHLY PREFERRED SKILLS, ABILITIES & QUALIFICATIONS:

• Juris Doctorate preferred
• Able to convey complex or technical information in a manner that others can understand and able to interpret complex information from others
• Proficiency with Microsoft Office applications and web-based technologies
  Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
  This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training

• Maintain up to date knowledge of federal and state regulations applicable to various lines of business.
• Review policies and procedures (clinical and non-clinical) to ensure they are accurate, current and in compliance with federal and state regulations.
• Interpret and disseminate information on regulatory and compliance matters.
• Educate and train all employees regarding compliance topics.
• Manage compliance hotline process, which includes investigations, follow-up, and corrective action measures if necessary.
• Conduct internal audits to ensure compliance with Stark, Anti-kickback, Conflicts of Interest, Fraud, Waste and Abuse, and other relevant laws and regulations.
• Serve as the Privacy Officer
• Develop and manages a team of compliance professionals
• Develop, initiate and maintain audits that correlate with EQH audit plans and Office of Inspector General (OIG) guidance for Medicare, Medicaid and other third-party payers pertaining to documentation, reimbursement and privacy activities
• Design and implement annual compliance work plan, including risk assessment
• Advise leadership on basic and complex preventative risk management assessment of processes, procedures and programs including in-service education
• Collaborate with Executive Leadership to develop and implement standards of conduct, related policies and procedures to continually meet national accreditation standards (e.g., URAC, NCQA)
• Ensure the Compliance Program effectively prevents and/or detects violation of law, regulations, organization policies or code of conduct
• Coordinate with the People & Culture team to ensure that the HHS-OIG List of Excluded Individuals and Entities (LEIE) checked with respect to all employees
• Review advertising and marketing materials to ensure that they are in compliance with state and federal regulatory requirements
• Perform other duties and responsibilities, as assigned