Chief Compliance Officer at AllyAlign Health in Remote
AllyAlign Health is a leading convener and owner of Medicare Advantage plans designed for senior housing residents. The company began reforming the health system in 2014 by enabling leading long-term care providers to launch provider-sponsored managed care plans for vulnerable senior populations. Today, AAH manages a number of comprehensive special needs plans to reduce healthcare costs and improve patient quality of life. For more SUMMARY The Chief Compliance Officer is responsible for developing policies and procedures, planning, implementing and managing activities that support the compliance program which focuses on the ability to achieve and sustain compliance with federal and state rules and regulations including adherence to all applicable accreditation programs. This position will be responsible for implementing compliance risk management strategies across the organization, coordinating all required documentation and audit compliance activities with the aim of ensuring timely response to requests from all health plan partners, accrediting and/or government agencies. This position will be responsible to direct all activities in preparation for compliance with regulatory and quality standards including the Centers for Medicare & Medicaid Services (CMS), Medicare Advantage plans, relevant State Medicaid agencies, State Departments of Insurance, US. Department of Health and Human Services (HHS), National Committee for Quality Assurance (NCQA), etc. This position will work closely with the plan partners and implement strategies to further increase successful adherence to guidelines for billing and adherence to all plan and delegation contractual requirements , and adherence to all plan and delegation contractual requirements. This person will also manage, facilitate, support, and monitor activities relating to compliance, including privacy and patient safety activities. This position will also be responsible for maintenance and monitoring of our compliance program, including development and maintenance of policies and procedures, leading on-site surveys or audits, implementation of all corrective action plans any deficiencies which may results from audits or surveys and ensuring that staff are appropriately trained in relevant compliance domains. This position is responsible for communication to management regarding all compliance activities and issues. This position will be responsible to coordinate responses to vendor assessment requests, complaint investigation, and licensure surveys. The role will collaborate with clinical, privacy, operations, and clinical quality teams/stakeholders to ensure that areas of vulnerability with regard to accreditation and licensing are identified and remediated. This position will work cross-functionally to guide improvement initiatives and promote a culture of safe and high-quality care. ESSENTIAL DUTIES Develop, implement, manage and monitor an effective Compliance, programs with appropriate supporting policies and tools to align with all organization components such as privacy and risk management. Create policies and procedures related to the various areas of the departments oversight in alignment with government laws and regulations. Comply with, promote, and support Company compliance with internal policies and procedures. Manage the day-to-day operations of the Compliance department. Develops and leads the regulatory readiness program in support of the organization's mission, values and business objectives. Collaborate with business owners to implement appropriate remediation activities when areas of deficiency are identified. Partners with the Security and Information Technology Services team to ensure compliance with privacy/security laws and regulations, evaluate potential privacy/security risks and solutions to increase the protection of sensitive information and participate in potential HIPAA violation investigations and response. Leverage laws, regulations, guidelines from the regulating bodies to provide guidance on complex compliance matters. Participate in the response to alleged violations of rules, regulations, policies, procedures and Code of Ethics and Business Conduct by evaluating the initiation of investigative procedures and depending on the issue, lead investigation activities. Develop and maintain an investigation process to identify and oversee the implementation of appropriate remediation activities and ensure corrective action within the required timelines. Respond timely and accurately to plan, payor, government and/or accrediting body audits/investigations Establish effective interdepartmental communications and coordinate compliance activities and improvements, both directly and through the appropriate committee structures. Align conduct with the Company's Code of Ethics and Business Conduct and support the Company's Ethics and Compliance Program. Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information. Acts as the primary contact and liaison for accreditation, licensure, and regulatory agencies. Coordinates surveys and site-visits from the Community Health Accreditation Program (CHAP), CMS, and other partners, including overseeing scheduling, activities, evidence requests, and remediation of open issues. Collaborates with subject matter experts in clinical, privacy, security, and quality to develop and implement corrective action plans for PHI data breach or other compliance-related concerns as well as proactive improvement initiatives. Keeps abreast of changes in legislation, requirements and timelines related to regulatory, accreditation, licensure, federal/state rules, and standards of excellence. Serves as a resource to respond to organization questions and interpretation related to accreditation, CMS, federal, state and local standards and regulations. Maintains familiarity with medical practice regulations in all locations where the organization operates. Assists in the coordination of responses to policy, subpoenaed records, or other complex requests/inquiries from health plan partners or government agencies. Services as Risk Manager, Compliance Officer, and Privacy Officer or other similar functions as necessary Prepares and maintains compliance documentation, files, and document libraries. Educational Requirements :
A minimum of a bachelors degree in business administration, law, healthcare administration or a related field is required. Certified in Healthcare Compliance (CHC) is preferred. Advanced degree and/or JD preferred Required Skills and Abilities:
5
years of compliance management/compliance officer experience working in healthcare; preferably in a compliance role within a Medicare/Medicaid health plan 10
years of experience in managed health care preferred, minimum of five years required Certified in Health Care Compliance preferred. Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication) Strong oral and written communication skills. Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results. Strong influencing and organizational skills, with the ability to apply good judgment and resolve ambiguities and influence multiple stakeholders. Experience related to accreditation and regulatory bodies, such as National Committee for Quality Assurance (NCQA), Joint Commission, AAAHC, COLA, CMS, CLIA, and/or State licensing agencies Working knowledge of quality improvement methodologies
Salary Range:
$200K -- $250K
Minimum Qualification
Auditing & ComplianceEstimated Salary: $20 to $28 per hour based on qualifications.
A minimum of a bachelors degree in business administration, law, healthcare administration or a related field is required. Certified in Healthcare Compliance (CHC) is preferred. Advanced degree and/or JD preferred Required Skills and Abilities:
5
years of compliance management/compliance officer experience working in healthcare; preferably in a compliance role within a Medicare/Medicaid health plan 10
years of experience in managed health care preferred, minimum of five years required Certified in Health Care Compliance preferred. Demonstrated knowledge of compliance concepts and practices (strategies, control activities, information analysis and reporting and communication) Strong oral and written communication skills. Strong analytical and research skills, able to synthesize information to provide practical solutions to accomplish meaningful results. Strong influencing and organizational skills, with the ability to apply good judgment and resolve ambiguities and influence multiple stakeholders. Experience related to accreditation and regulatory bodies, such as National Committee for Quality Assurance (NCQA), Joint Commission, AAAHC, COLA, CMS, CLIA, and/or State licensing agencies Working knowledge of quality improvement methodologies
Salary Range:
$200K -- $250K
Minimum Qualification
Auditing & ComplianceEstimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
