Kewa Pueblo Health Corporation Hiring for Compliance Officer Job at Santo Domingo Pueblo, NM Full Time

MISSION & VISION STATEMENT:

The Kewa Pueblo Health Corporation (KPHC) is established for the purposes of carrying out the vision and mission of the Santo Domingo Health Center (SDHC). The MISSION of KPHC is: “ENSURING HEALTH & WELLNESS THROUGH EXCELLENCE IN HEALTHCARE WITH RESPECT FOR CULTURE” and the VISION OF KPHC is: “HEALTHY PEOPLE, HEALTHY COMMUNITY, and HEALTHY LIFESTYLE”.

POSITION PURPOSE:

This position is responsible for the oversight of the development, implementation and administration of the compliance and/or risk programs to maintain an environment conducive to patient and staff safety, prevent or minimize losses associated with identified risks, and to minimize claims.

PERFOMANCE EXPECTATIONS:

In performance of their respective tasks and duties all employees of the Kewa Pueblo Health Center are expected to conform to the following:

· Uphold all principles of confidentiality and patient care to the fullest extent.

· Adhere to all professional and ethical behavior standards of the healthcare industry.

· Interact in an honest, trustworthy and dependable manner with patients, employees and vendors.

· Possess and maintain an environment of cultural awareness and sensitivity enabling the facility to fulfill its mission by meeting or exceeding its goals.

· Take responsibility for all day-to-day operations of the facility and health services provided to the patients.

· Maintain a current insurable driver’s license.

· Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well

· Consistently maintains professional and ethical standards adhering to all KPHC Policies, Compliance Standards and HIPAA.

ESSENTIAL DUTIES, FUNCTIONS & RESPONSIBILITIES:

· Develop, maintain, and coordinate the compliance program.

· Serve as Privacy Officer and Chair the compliance and risk management committees.

· Develop, administer, and monitor implementation of a KPHC-wide plan to ensure compliance with state, federal and accreditation requirements, including but not limited to requirements of CMS, AAAHC, HIPAA, CLIA and OSHA.

· Conduct HIPAA investigations as needed, assess violations, and create a plan for addressing such violations in collaboration with the Human Resources Director.

· HIPAA violations to necessary parties.

· Work with programs in the preparation, development, and implementation of written policies and procedures to achieve compliance with state, federal and accreditation standards.

· Develop and implement a compliance training program for all employees, including orientation and on-going education, to ensure compliance with state and federal laws and regulations.

· Ensure compliance with revenue generation and reimbursement rules and regulations from CMS and other federal or state funded health care programs.

· Determine the degree to which the organization meetings and/or exceeds compliance standards through audits and other evaluation tools and systems.

· Ensure that the medical staff appointees and independent contractors are in compliance with applicable standards, especially with regard to credentialing, coding and billing practices.

· Coordinate the processing of internal and external compliance complaints with appropriate agencies.

· Recommend and implement solution strategies for identified compliance issues.

· Develop, maintain, and coordinate the clinical risk management program.

· Develop, administer and monitor a company-wide plan for risk identification, investigation and reduction.

· Perform risk assessments in clinical settings and inspects patient care areas.

· Collaborate with quality and safety personnel to develop performance goals, and to investigate potential or actual occurrences/incidents. Participates in root cause analysis investigation and ing.

· Collect, evaluate and present relevant data on risk management claims and issues to various levels of management.

· Recommend and implement resolution strategies for identified risk management issues.

· Provide guidance, interpretation and make recommendations to the Executive Leadership Team on matters related to clinical risk management and compliance.

· Prepare and submit s to the Executive Leadership Team and the Board as directed.

· Maintain currency on pertinent laws and standards governing health services compliance and risk management, and maintain professional credentials through continuing education.

· Responsible for review of policies and procedures contracts and external agreements prior to presentation to the Board of Directors for formal approval.

· Ensure adherence to ing requirements for IHS or any external funding agencies.

· Serve as a liaison for the Board of Directors.

· Facilitate a positive working relationship with the Board of Directors, KPHC CEO, and KPHC Personnel in verbal, written and electronic communications.

· Perform other duties as assigned.

MINIMUM MANDATORY QUALIFICATIONS:

Education:

· Bachelor’s degree in Finance, Accounting, Business or Health Care Administration or a related health profession.

Experience:

· Five (5) years of health care compliance officer professional experience within an ambulatory care setting.

Mandatory Knowledge Skills, Abilities and Other Qualifications:

· Thorough understanding, knowledge and application of research, analysis, and assessment of compliance with federal regulations related to CMS, HIPAA, Affordable Care Act, and other government laws and programs related to the healthcare industry.

· Knowledge and understanding of the principles, procedures and associated regulations and standards for the delivery of rural, community-oriented health care delivery systems.

· Familiarity with Indian Self-Determination contracting and the IHS system.

· Computer literate and knowledgeable of various computer technologies and software; including the IHS RPMS/EHR/NextGen and other comparable systems.

· Self-motivated, goal oriented and flexibility to adapt to frequently shifting priorities.

· Requires a professional image/demeanor as well as an extremely responsible working attitude with oral and written communication skills being an absolute necessity. Individual must exhibit the highest level of integrity and ethics.

• Frequently required to provide immediate response/assistance to the organization and its employees.

· Knowledge of principle and policies of fiscal, accounting, budgeting and statistical analysis.

· Knowledge of standardized data processing rules, specialized coding, billing, A/R and medical terminology preferred.

· Knowledge of the Privacy Act, confidentiality and applicable rules and guidelines.

· Extensive knowledge of appropriate accrediting and certification requirements, such as AAAHC.

· Ability to work day, evening, weekend or holiday shifts.

· Familiarity with the mandatory ing requirements under the Indian Child Protection Act, concerning suspected incidence of child abuse or child neglect.

PREFERRED QUALIFICATIONS:

· Prior experience working with Indian Health Services (IHS), a Tribe or Tribal Organization.

· Master’s Degree in a related field.

· Bilingual skills in English and the Keres native language.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. This position may be exposed to certain health risks that are inherent when working within a health center facility.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicate with patients, vendors and staff.

MENTAL DEMANDS:

There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues.

OTHER:

All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Retirement plan
• Tuition reimbursement
• Vision insurance

Physical setting:

• Office

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: One location