2 days old

Healthcare Compliance Director

Performant Financial
Lathrop, CA
  • Job Code
Performant Financial Corporation

Performant Corporation is an Equal Opportunity Employer (Minorities/Females/Disabled/Veterans).

Healthcare Compliance Director
Job Code:2017-10-2-012
Location:Remote - Lathrop, CA
Status:Regular Full Time

General Description and Essential Job Functions

As the Healthcare Compliance Director you will research and analyze client and regulatory requirements, and apply to enhancing business practices and operations, as well as developing tools and infrastructure to support compliance best practices for our healthcare business. A qualified candidate will have expertise related to health care regulations and business practices, with an extensive track record that demonstrates the candidate’s ability to apply compliance procedures and programs at an enterprise level to sufficiently address legal obligations, meet client and customer demands, and ensure organizational integrity. 

• Develop and administer an effective compliance oversight program that will suit regulatory needs and our clients’ compliance requirements; and 
• Working in partnership with business owners to develop creative client solutions and unlock added value on each business case that may not be known to the client or business owners.

The following are specific duties and essential job functions:
• Incident monitoring, auditing and reporting for:
-Violations of law or rule, or violation of a contract term or provision;
-Violations of laws applicable to any Medicare and Medicaid contracts or Federal health care program;
-Integrity violations of any Medicare or Medicaid contract term or provision;  
-Disclosure procedures for incidents; and
-Fraud, waste, and abuse. 
• Self-assessment and attestations related to health care compliance with corrective action plans where/when needed. 
• Working closely with business owners to coordinate client audits and on some occasions act as liaison between company and clients when gathering and responding to audit inquiries and requests for information.
• Maintaining state licensure requirements and keeping up with state laws governing the health care business.
• Maintaining compliance with governing laws (state and federal) related to health care business.
• Development and implementation of security policies and procedures related to HIPAA and other laws governing health care audit, recovery, and reclamation services. 
-Security awareness and training (including incident response and reporting);
-Security incident procedures to meet contractual and legal requirements; and
Working closely with InfoSec on other security related policies and procedures specific to health care.
• Work with other internal departments to implement procedures set forth in CMS Risk Management Handbook and monitor compliance.
• Implement company business practices, procedures, polices and internal controls for compliance, such as:
-Preventing conflicts of interest, prohibiting the use of non-public information accessed through our client and customer contracts for personal gain, and obtaining a signed non-disclosure agreements to prohibit disclosure of non-public information;
-Conducting internal and assisting with external audits;
-Policy Enforcement and employee disciplinary actions for compliance related violations;
-Retention of Records;
-Management of subcontractors related to health care compliance;
-Informing employees, through an employee education and training program, of their  obligation to disclose and prevent compliance violations, not to use non-public  information for personal gain, and to  avoid even the appearance of personal conflicts of interest; and Reporting violations.
• Identifying security gaps and provide feedback to departments on addressing security gaps in a manner that’s consistent with CMS Information Security website and its provisions.
• Create and implement procedures modeled by common BAA provisions. 
• Health Care Code of Ethics: Develop and apply. To include components such as integrity, accountability, fair dealing, privacy and security, and communications. 
• Monitor, screening and reporting of employees and subcontractors debarred, excluded or otherwise ineligible for participation in federal health care programs or government contracts, and working with Human Resources as necessary to implement necessary safeguards for monitoring, screening and reporting procedures.  
• Establish contingency process for key functions to ensure business continuity.
• May directly or indirectly provide direction, work assignment instruction, guidance, training and development of other employees.
• Acts in best interest of the Company.

Non-Essential Functions:
-Other duties and responsibilities as may be assigned.
Required Skills and Knowledge:
• Comprehensive knowledge of health care data mining and analytical services for medical record audits, validation of claims, and post-insurance-payment recovery.
• Comprehensive knowledge of PHI and 45 CFR §160.103 with ability to implement procedures designed to safeguard PHI. 
• Comprehensive knowledge and application of HIPAA, 42 U.S.C. § 1320d, 45 CFP Parts 160, 161, and 164.
• Comprehensive knowledge HITECH and ability to apply compliance measures designed to comply with its provisions. 
• Comprehensive knowledge and familiarity with federal laws and regulations designed to prevent or ameliorate fraud, waste, and abuse. 
• Basic knowledge and familiarity with False Claims Act.
• Basic knowledge and familiarity with anti-kickback statute.
• Comprehensive knowledge and application of FARS related to health care government contracts.
• Comprehensive knowledge of CMS Medicare and Medicaid, and specifically:
-Recovery Audit Contractor (duties, functions, and overall application to CMS); and
-Medicaid Reclamation (duties, functions, and overall application to CMS).
• Comprehensive knowledge and application of state laws pertaining to Medicare RAC and Medicaid Reclamation.
• Basic understanding and application of CMS Information Security Program(s):
-Business Partner Systems Security Manual (BPSSM); and
-CMS IT Security Policy documents, such as the ARS, PISP, Minimum Security Configurations, Wireless Access Policy. 
• Comprehensive knowledge and application of conflict of interests related to health care RAC and Reclamation services. 
• Foundational knowledge of CMS Risk Management Handbook.
• Comprehensive knowledge and application of CMS Information Security Procedures.
• Comprehensive knowledge with identifying fraud, waste and abuse.
• Basic understanding of requirements under CMS Information Security website.
• Understand the purpose and functionality of BAA’s; and the ability to apply common provisions under BAA’s to business operations. 
• Excellent verbal and written communication skills; effective listening, but also persuasively convey opinions, recommendations and counsel; distills large amounts of complex information to compliant, appropriate and effective communications and tools.
Applies strong research ability and analytical skills appropriately to issues, data, programs and other areas to  problem solve, identify root causes, trends, and develop recommendations. 
• Applies excellent judgement in actions and decisions in the best interest of the company.
Unwavering commitment to ethics and confidentiality.
• Delivers excellent results given direction in the form of objectives.
• Leverages excellent management skills to directly or indirectly provide direction, work assignment instruction, guidance, training and development of other employees.
Strong customer service focus and business partnership orientation.
• Demonstrated ability to develop healthcare compliance management infrastructure, tools, procedures, policies and programs from the ground up.
• Investigates and applies strong analytical skills appropriately to issues, data, programs and other areas to  problem solve, identify root causes, trends,and develop recommendations.
• Action oriented results driven leader that can rapidly shift gears in a fast paced dynamic and complex environment while maintaining a positive ‘can- do’ attitude.
• Leads by example and is a servant leader that adds value daily scaling from planning, developing, problem resolution and coaching, to rolling up your sleeves to ‘get things done’.
• Able to travel up to 30% of time.

Physical Requirements
Job is in a busy standard office environment with moderate noise level, sits at a desk during scheduled shift, uses office phone system; views a computer monitor, types on a keyboard and uses a mouse. Reads and comprehends information in electronic (computer) or paper form (written/printed).
- Sit/stand 8 or more hours per day; has the option to stand as needed while on calls; reach as needed to use office equipment.
- Consistently viewing a computer screen, typing, using a keyboard and mouse.
- Uses phone; head-set can be provided.
- Occasionally lift/carry/push/pull up to 10lbs.
Education and Experience:
• Bachelor’s degree in relevant field.
• Certified in health care compliance and health care privacy. 
7-10 years’ experience serving as a healthcare compliance professional, with responsibility for developing and managing compliance programs for: (1) medical insurance carriers, with an emphasis on reclamation services, auditing, third-party liability, FWA (Fraud Waste & Abuse), and Medicaid laws; and (2) CMS under the Medicare and Medicaid program; a state agency under its Medicaid program; or an auditing and recovery vendor for federal or state agencies, or [preferably] commercial carriers. 

Performant is a government contractor. Certain client assignments for this position may require submission to and successful outcome of additional background and/or clearances throughout employment with the Company. 

- Must submit to and pass background check.
- Must not have any Federal or State liens resulting from County, State or Federal tax issues. 
- Must not have any current defaulted student loans.
- Must be able to pass a criminal background check; must not have any felony convictions or specific misdemeanors.
- Must submit to and pass drug screen.

Job Profile is subject to change at any time. 

Performant Financial Corporation is an Equal Opportunity Employer. Performant Financial Corporation is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.


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Healthcare Compliance Director

Performant Financial
Lathrop, CA

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Healthcare Compliance Director

Performant Financial
Lathrop, CA

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