Compliance Director

Job Description

• Act as Compliance, Quality Assurance and Mental Health Abuse Investigations Director for the organization.
• Responsible for development, day-to-day management, and oversight of the compliance, quality assurance and mental health abuse investigation programs.
• Complete an annual compliance work plan, an annual Quality Assurance (QA) plan, an agency-wide risk assessment, and maintain and submit an annual HHS Breach Report.
• Revise and oversee agency compliance and privacy policies/procedures, agency records, contracts, Business Associate agreements, and standards of conduct to ensure agency policies are updated regularly, comply with evidence-based practices, and in accordance with statutes and state and federal regulations.
• Develop and implement a training program that include:
• Agency-wide training for new employees on compliance, prevention of fraud, waste & abuse, and Lifeways’ Code of Conduct, HIPAA privacy regulations.
• On-going clinical, compliance, and QA training for employees working in high-risk positions.
• Regularly report to the CEO and Board of Directors on efforts to develop and implement effective compliance, privacy, and quality assurance programs.
• Communicate to employees the importance of reporting suspected wrongdoing to Lifeways and manage anonymous and confidential reporting mechanisms including a “hotline” for reporting suspected misconduct, fraud, waste, or abuse.
• Conduct regular audits of agency compliance records, billing, electronic medical records including service documentation and privacy records, to help reduce agency risk, breaches, destruction & retention, and to comply with regulations.
• Direct investigations into compliance related activities and potential breaches of Personal Health Information,
• Direct mental health screening and investigation of potential abuse and ensure 24/7-365 screening of abuse reports as per Oregon Administrative Rules (OAR’s).
• In conjunction with the CEO, Lifeways Board, and Lifeways legal counsel determine appropriate agency response to detected violations.
• Organize and participate in QA, Coordinated Care, Compliance, HIPPA Compliance and other job-related committees.
• Direct response of privacy practice complaints and client and community partner complaints associate agreements for privacy requirements, and daily review of reportable QA incidents.
• Ensure regular inspections of agency facilities and privacy practice procedures, and ongoing monitoring of business.
Compliance:
• Implement, manage, and monitor compliance program, in collaboration with Executive Management.
• Ensure ongoing surveillance of clinical service documentation, billing practices, and OIG FFP exclusion requirements.
• Monitor and respond to confidential and anonymous reports of fraud, waste, abuse, or other illegal or unethical reported behaviors.
Quality Assurance:
• Develop, implement, and conduct systematic continuous assessment of clinical documentation, quality of service and client outcomes.
• Direct interpretation of QA and behavioral healthcare rules and provider regulations
• Direct clinical service and billing audits
• Direct and report on quality improvement, data analysis, and consumer satisfaction surveys.
Privacy:
• Coordination of HIPAA privacy compliance activities
• Help establish and maintain a mechanism to track access to protected health information as required by law.
• Oversee the Privacy Rules of clients to inspect, amend, and restrict access to their protected health information (PHI).
MH Abuse Investigations:
• Monitor abuse screening timelines and report submissions of agency MH abuse investigators.
• Liaison with the OHA Office of Investigations, Training, and Safety (OTIS) as needed.