Chief Compliance Officer
Administration | Lost Creek Office, Austin, TX | Full Time
This position oversees the Corporate Compliance Program by independently and objectively reviewing and evaluating compliance issues within the organization. Serves as the final internal resource to receive and resolve compliance issues/concerns.
- Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
- Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, and resolved
- Identifies potential areas of compliance vulnerability and risk, develops/implements corrective action plans for resolution of problematic issues, and puts practices in place to avoid such situations in the future
- Ensures corrective actions are adequate and have been implemented for all identified compliance deficiencies.
- Assist in the creation, generating, and updating of Plans of Action and Milestones (POA&M) for client audits-mainly national Payers and Provider organizations.
- Assist with performing audits for the following compliance areas SSAE18/SOC2, PCI-DSS, HITRUST, NIST and other framework audits.
- Assist with Payer related continuous monitoring and compliance activities.
- Assist with Disaster Recovery test exercises documentation updates.
- Act as IT security liaison between external clients and internal teams to assess risk, identify, develop, and enforce policies, procedures and internal controls.
- Maintain a detailed knowledge of contractual requirements and state contract requirements
- Implements appropriate programs to prevent, monitor and detect fraud, waste and abuse.
- Ensure legal/regulatory compliance and contract compliance
- Maintain current and accurate tracking records/systems related to notice of action letters.
- Participate in other project management and compliance activities as assigned to meet departmental and company objectives and requirements.
- Assist in promoting awareness related to information privacy and security and enforce compliance with applicable state and federal laws
- Keeps senior management informed of the operation and progress of compliance efforts
- Master’s Degree Health Care Administration, Business Administration or compliance certification is required; Minimum of five (5) years Healthcare experience or training
- Experience in a Compliance and Privacy requirements for Medicaid Managed Care Program or experience in public sector services such as Medicare, Medicaid, Community Health, Public Health or Social Services
- Deep expertise in helping Healthcare services organizations in setting up compliance practices and compliance organization structure to ensure successful audits
- Working knowledge of the National Committee for Quality Assurance (NCQA), URAC, or general accreditation policies and procedures
- Working knowledge of Healthcare Efficacy Data Information Set (HEDIS) requirements and other Provider Quality reporting initiatives
- Familiarity with the following security and compliance frameworks: ISO, CSA-STAR, PCI-DSS, FISMA, HIPAA, NIST, SSAE16/SOC2, and FedRAMP
- Sound knowledge of Federal IT Compliance Standards
- Extensive knowledge of established and changing healthcare regulations
- Knowledge of coding and reimbursement systems, risk management and performance improvement
- Experience in behavioral health environment a plus