Director, Compliance and Privacy


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Job Number 47817
Posted 6/15/2017
Account EMHS
Department Beacon Communities
Location EMHS - Cianchette Building, Brewer, ME 04412
Schedule Regular Full-time
Shift Day
Hours 8-5
Job Details POSITION SUMMARY:

The Beacon Health Director of Compliance and Privacy will oversee the Beacon Health compliance program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. The position ensures the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies, that the necessary company policies and procedures are in place and being followed and that behavior in the organization meets the company's standards of conduct.

While ultimate responsibility and oversight of the ACO's compliance activities rests with the Board of Directors, the Beacon Health Director of Compliance and Privacy is the focal point of all compliance activities and should be viewed by all employees, managers and contractors as a valuable and confidential resource for questions related to compliance. By adhering to these principles, Beacon Health will achieve the legal compliance required under the law and to which the Board of Directors expects all members, partners, participants, participant employees, managers and contractors to adhere.

Reports Directly to: Board of Directors, President Beacon Health.

Matrix reporting to: EMHS VP/Chief Compliance and Internal Audit

Officer.

PRIMARY RESPONSIBILITIES:
  1. Serving as a role model to all Beacon Health employees and partners, including through demonstrating the highest levels of professionalism, integrity, and ethical behavior.
  2. Ensuring that Beacon Health conducts its activities in compliance with all federal, state and local laws and regulations and in conformance with the highest standards of business integrity.
  3. Designing, implementing and maintaining Beacon Health's compliance program to help all members, partners, participants, participant employees, managers and contractors achieve these objectives by establishing general overall framework for conducting our activities with integrity and accountability pursuant to a shared set of ethical and legal principles
  4. Ensuring Beacon Health is compliant with all of its contracts and agreements including but not limited to CMS (Pioneer/Next Gen); CMS Medicare Shared Savings Program; MaineCare risk contracts, Commercial payor arrangements; Employer; Vendor and Consulting contracts.
  5. Establishing processes and policies that ensure compliance with marketing to beneficiaries and managing participating provider files.
  6. Collaborating with Beacon Health member/partner organizations regarding local policies that support the ACO compliance activities.
  7. Overseeing all day to day aspects of the ACO's compliance program.
  8. Ensuring the effectiveness of the compliance program through auditing and monitoring. Develops and maintains a compliance auditing/monitoring plan for the organization based on an objective risk assessment. Conducts internal audits, reviews, and other investigations. Documents all corrective action and reports these findings to the EMHS VP Chief Compliance Officer and Board of Directors no less than quarterly
  9. Overseeing development, implementation, maintenance and adherence of and to the organization's policies and procedures in compliance with federal and state laws and regulations as well as ethical standards, including related to privacy and information security.
  10. Promoting open and non-punitive communication between healthcare workers, patients and families regarding clinical and environmental safety.
  11. Publicizing and maintaining a reporting system whereby employees can report compliance issues and concerns without fear of retaliation.
  12. Responding to requests for evaluation of issues from employees within the organization. Acts as a facilitator for the investigation and subsequent resolution of any issues. Follows established EMHS protocols for all investigation activities.
  13. Managing compliance audit requests from all external entities, including CMS, MaineCare, Commercial payers, etc.
  14. Monitoring compliance with legal and accrediting requirements related to areas of responsibility functions and services. (e.g., NCQA Care Management Certification).
  15. Working collaboratively with Information Systems and security personnel on compliance with FISMA and HIPAA.
  16. Assisting management and legal counsel with contract development to assure compliance with applicable licensure requirements, laws and regulations.
  17. Working with human resources personnel to monitor and ensure the consistent enforcement of compliance expectations through appropriate disciplinary action.
  18. Working with human resources personnel to ensure proper background checks are performed when required.
  19. Instituting and maintaining an effective Beacon Health Compliance Communication program, including promotion of the (a) use of the "hotline", (b) heightened awareness of the organization Code of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
  20. Maintaining a strong awareness of existing laws and regulations affecting Beacon Health while keeping abreast of current changes that may affect healthcare systems and accountable care organizations. Informs the employee population regarding these compliance matters through personal initiatives, seminars, training programs, peer contact, and other education efforts.
  21. Assisting Beacon Health leadership team in program planning and development of Business Plans. Provides analysis of business plans and budget as requested.
  22. Creating a self-development plan to improve leader skills, competence, and outcomes.
  23. Serving as the Beacon Health Privacy Officer.
  24. Working closely with other EMHS Member compliance and privacy officers, including actively participating as a member of the EMHS Compliance Task Force.
  25. Identifying issues that require input from and/or approval of EMHS Legal Services and referring these issues for legal review and resolution. Assists Legal Services in analyzing Beacon Health-related legal and compliance issues.


EDUCATION AND/OR EXPERIENCE:

Bachelor's degree required. Master's degree in healthcare related field preferred. Law degree strongly preferred.

Minimum of five years' experience in health care compliance or management preferred. Thorough knowledge of hospital or medical group operations preferred. Familiarity with operational, financial, quality assurance, and human resource procedures and regulations preferred.

PHYSICAL REQUIREMENTS:

Light lifting of files and manuals, some bending to file. Light to medium carrying up to 50 lbs., straight pulling/pushing, reaching in all directions, stooping, walking long distances, standing, sitting, repetitive motion/finger activity for sustained periods of time, speaking, hearing, moderate phone contact, visual activity; long periods of sitting and working on computer.

WORKING ENVIRONMENT:

Office environment, well-heated and well-ventilated. Ergonomically correct work station.


The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.
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