Under the administrative direction of the Chief Executive Officer (CEO), and in collaboration with the Executive Team, the Compliance and Risk Officer (CRO) is responsible for overseeing and monitoring RFHC's compliance, privacy and risk management and patient experience programs. The CRO also has oversight of contract administration.
The position ensures that the Board of Directors, management and employees are in compliance with the rules and regulations of regulatory agencies; that company policies and procedures are followed, and that behavior in the organization meets the company's Standards of Conduct. Compliance monitoring responsibilities of federal, state, county and other regulatory expectations include, but are not limited to: clinic licensing and certification, HIPAA/HITECH, CMS, OSHPD, OSHA, Health Resources Service Administration (HRSA) and the Bureau of Primary Health Care (BPHC), Health Plan of San Mateo (HPSM) and other health plans, CDC, Vaccines for Children (VFC), and the San Mateo County Health Department.
The Compliance and Risk Officer is a member of the Executive Management Team and in his /her compliance role directly reports to the Board of Directors Compliance and Risk Committee. As part of his/her compliance and risk management functions, he/she will perform patient chart audits together with RFHC staff and/or consultants to assess individual and organizational compliance with RFHC policies and procedures. The position oversees facility
licensing compliance, including CLIA, retail pharmacy license and staff credentialing. This position is a member of the administrative team supporting NCQA's Patient-Centered Medical Home standards and practices.
ESSENTIAL DUTIES AND RESPONSIBILITIES
To be performed in accordance with RFHC Policies and Procedures
COMPLIANCE DUTIES AND RESPONSIBILITIES
Develop, initiate, maintain, and revise compliance policies and procedures for the operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper
Establish and provide direction and management of the Compliance Review monthly Compliance Hotline reports to evaluate results and trends, review specific reports, and coordinate case management of incidents if necessary. Provide training to all new staff to report suspected fraud and other improprieties to the hotline without fear of retaliation.
Design, coordinate conduct and/or oversee investigations on matters related to compliance (eg. respond to the incident reports, Compliance Hotline calls, or suspected violations). Prepare written reports of investigations with recommendations for corrective action for the Board of Directors, CEO, CMO, Director of Clinical Operations and department managers, as
Develop and coordinate annual internal compliance review and monitoring activities, including periodic departmental and medical records reviews for compliance in medical record documentation, coordination and continuity of care, health prevention, site personnel qualifications and training as it relates to scope of practice, HIPAA, office management practices and other areas as specified by licensing and external regulatory agencies. Develop recommendations for corrective action based on review findings. Follow up on reviews to verify that corrective actions have been implemented.
Ensure compliance with HIPAA privacy practices and promote activities and education to foster information privacy awareness within the
Review organizational policies and procedures to ensure compliance with legal, accreditation, and internal standards. Analyze existing policies, identify gaps and recommend new/revised policies and procedures, approval processes, and monitoring methods for departmental use. Review detailed departmental processes and policies and document
Present new or revised policies and procedures to Board of Directors for approval
Serve as organizational liaison for clinic licensing and certification, HRSA, CMS, HSPM, VFC, CHDP, CDP, VHP, SCFHP, San Mateo County Health Department, and other external agency audits
Present external audit reports to CEO and Compliance Steering Committee and/or appropriate members of the Executive team as appropriate and oversee development of and adherence to a corrective action plan for any identified
RISK MANAGEMENT DUTIES AND RESPONSIBILITIES
As the health center's Risk Officer, this position performs a variety of duties related to managing potential risks and liabilities within RFHC facilities and in RFHC personnel work performance, by creating and implementing policies that improve both patient care and employee safety. The Risk Officer conducts periodic risk assessments and educates and trains providers and staff on potential risks and how to avoid or mitigate them. The position also works with the health center's legal counsel and insurers in situations of medical malpractice or workers' compensation claims. The position does not provide direct patient care services, but, typically, the Risk Officer's time is split between administrative offices and clinic areas. The position interacts with patients, employees, clinic administrators, vendors, and external inspectors and auditors, and is capable of resolving escalated issues arising from operations and requiring coordination with other departments and/or leadership.
Review and maintain log of all patient experience and incident reports. Report trends and sentinel events to the Board Compliance and Risk Committee on a quarterly
Monitor Patient Experience Hotline and log calls on a daily
Investigate matters related to complaints and incidents, including conducting internal investigations (eg. responding to patient experience reports, Ravenswood Cares form, and patient experience hotline calls).
Prepare written reports of the investigation with recommendations for corrective action for the CEO, CMO, Clinical Operations Director and/or department
Analyze patient experience and incident report logs and sentinel events to identify areas for improvement. Prioritize issues in risk assessment based on level of organizational Present investigative findings and recommendations to the Clinical Quality Management (CQM) Team,
Report incidents resulting in patient injury to NorCal and (FTCA) Intermediary for HRSA as
Manage and process claims-related incidents and serve as the health system's claims point of contact.
Oversee ergonomic risk management to reduce employee work related
Report any unusual or recurring patient care issues that arise from the survey results to the CEO, CQM Team, Compliance Steering Committee and/or Board Compliance and Risk Committee, as needed
Certified in Healthcare Compliance (CHC)
Certified in Healthcare Privacy Compliance (CHPC)
Certified Professional in Healthcare Risk Management (CPHRM), highly desirable
Masters or higher degree from an accredited college or university in public health, health administration, business administration, public policy or related field.
Doctor of the Science of Law, JSD, preferred
Minimum 5 years compliance experience in an ambulatory health care services environment.
Familiarity with Stark Law, False Claims Act, HIPAA/HITECH, Anti-Kick Back Statute, Compliance oversight, Corporate Integrity Agreements (CIA), Medicare/Medicaid & 340B Programs, Investigations, Health Plan Contracts, Patient Satisfaction, Staff Compliance Training, Monitoring and Auditing
Skill in Project Management, Physician Relations, Contract Management, Problem Resolution, Continuous Improvement, Relationship Building
Computer literate in a PC Environment
Excellent verbal and written communication skills
Flexible, able to respond to incidents based on urgency and priority, multitask oriented
Ability to work independently and collaboratively in a multicultural and ethnically diverse population
Current California Driver's License in good standing, a personally owned, currently insured vehicle to drive on work related business
Additional Salary Information: Paid medical, dental and vision benefits; 403b;
Internal Number: CRO
About Ravenswood Family Health Center
We are a non-profit community health center that provides primary medical and dental care and prevention services for all ages; including the uninsured and new immigrants, regardless of ability to pay. We have a bilingual staff of over 200 full and part-time employees and contractor here to serve our patients.