Compliance Officer and Risk Manager

Job Purpose:

The Compliance Officer & Risk Manager works under the direction and supervision of Executive Director and collaborates with the Medical Director. The Compliance Officer & Risk Manager oversees the day-to-day operations as it relates to compliance. The Compliance Officer & Risk Manager completes ongoing evaluation of quality patient care, by means of identifying areas of improvement and ways to implement efficient change, and ensures compliance with regulatory requirements, and applicable laws, rules, policies and procedures. The Compliance Officer & Risk Manager’s goal is to secure the functionality of SMDC to drive extensive and sustainable growth of all departments while supporting SMDCs mission, vision and core values.

Job Duties and Responsibilities:

(Note: Duties and responsibilities may be added, deleted, or changed at the sole discretion of Sycuan Management at any time)

Strategic:

Ensures quality assurance and control, patient satisfaction and compliance monitoring.

Ensure staff achieve peak productivity and performance. Ensures training and adherence of clinic staff to policies, procedures, and, standards; coordinates in-service training, continuing education, orientation, competency reviews, and other related training functions with department supervisors.

Oversees patient care and coordination of care in collaboration with the health and dental care teams.

Oversees and guides efficient patient flow from entry to dismissal with policies and procedures that align with all departments of SMDC. 

Directs, organizes and formulates monthly, and/or annual clinic performance reports associated with practice operations, including financial measures to monitor program goals, staff effectiveness and scheduling efficiencies.

Creates a positive and engaging work environment for staff by setting clear expectations, coaching for success, issuing performance documentation as needed, onboarding and training for development or bridging skills gap.

Develops positive, trusting, and collaborative relationships with SMDC management team to ensure open communication, provide feedback, and influence change as needed.

Develops and maintains excellent working relationships with all departments; provides guidance and support as appropriate to ensure needs are met in a timely manner.

Provides real time meaningful feedback to various departments to effect change in a timely manner.

Compliance:

Ensures development and compliance of workflows and policies and procedures consistent with those of the organization to ensure efficient and safe operation of the practice site and compliance with federal, state, and other regulatory and accreditation agencies.

Manage the ongoing review of materials and communication tools to ensure departments meet compliance requirements.

Adhere to regulatory reporting guidelines and filing deadlines in collaboration with Revenue Cycle Coordinator.

Conduct compliance audits and interprets these reports for various departments.

Facilitate remediations of audit findings by training staff to make course corrections and prevent future violations.

Researchers and reports on the most cost-effective plans to minimize asset liability.

Reviews and analyzes risk management programs for the effectiveness of coverage and to reduce costs and losses.

Develops and administers risk management and loss prevention programs.

Program:

In collaboration with the Executive Director, Medical Director, Dental Director, and Pharmacist/Pharmacy Manager - assists in coordinating clinical activities that directly impact population health outcomes.

Monitors, facilitates data validation and provides feedback for data tools and dashboards to monitor program goals in collaboration with Quality Manager.

Oversees projects for effective implementation and ongoing monitoring.

Gathers and analyzes data for trends and to institute action to solve problems promptly and evaluate effectiveness of action in collaboration with Quality Manager.

Leads employees to encourage maximum performance and dedication to SMDC.

Contributes to the success of the organization by participating in quality improvement activities.

Complies with all Sycuan Medical Dental Center policies and procedures and proactively participates in the implementation of new initiatives.

Fosters a positive patient experience and promotes patient retention.

Participate in expansions activities as appropriate.

Financial:

Monitors productivity reports to ensure schedules are maximized to meet goals.

Assess optimal staffing ration for staff to adequately support the volume of the clinic.

Risk:

Identify, document, and ensure communication of key risks and recommend ways to control or reduce risks.

Gather risk-related data from internal or external resources.

Identify and analyze areas of potential risk to the assets, earning capacity, or success of organizations.

Develop or implement risk-assessment models or methodologies.

Produce reports or presentations that outline findings, explain risk positions, or recommend changes.

Plan, and/or contribute to development of, risk management systems.

Develop contingency plans to deal with organizational emergencies.

Evaluate applicable laws and regulations to determine impact on organizational activities.

Responsible for implementing, administering, monitoring, and evaluating the IHC Workplace Safety Program.

Conducts periodic audits and risk assessments.

Responsible for implementing, administering, monitoring, and evaluating IHC’s Emergency Preparedness/Disaster Plan.

Functions as the Indian Health Center’s Incident Commander in the event that IHC’s Emergency Preparedness/Disaster Plan is activated.

Insures that Safety Committee is trained on IHC Emergency Preparedness/Disaster Plan.

Functions as the Indian Health Center’s Safety Committee Chairman.   

Handles patient grievances and incidents.

Job Specifications:

Education and Experience:

Essential:

• Bachelor’s Degree from an accredited college or university or equivalent education and experience.

• Available for all shifts/assignments and, when required, able to work evenings and weekends
• Valid CA Driver’s License or the ability to obtain upon hire

Desirable:

• Tribal Clinic experience
• Multi-lingual

Skills and Knowledge:

Essential:

• Excellent English oral and written communication skills
• Excellent knowledge of medical clinic protocols
• Ability to complete forms and documents
• Ability to prioritize and perform multiple tasks
• Ability to maintain confidentiality
• Ability to appear for work at scheduled time
• Ability to maintain professionalism and composure
• Ability to accept constructive criticism
• Excellent knowledge of laws and regulations governing medical records and medical office management
• Ability to provide excellent internal and external customer service
• Familiarity with health care operations, quality assurance.
• Knowledge of Federally Qualified Health Center (FQHC) requirements
• Knowledge of licensing regulations
• Knowledge of Indian Health Services
• Demonstrate the ability to operate a multi-line phone system
• Possess working knowledge of Microsoft Office and Google Suit

Physical and Mental Requirements:

• Able to lift/move up to 40 pounds, move from place to place, and stand for long period of time
• Ability to do math, organize and prioritize workload, work effectively and efficiently under stress
• Ability to supervise, multitask, understand and follow instructions
• Ability to proficiently read, write, speak and understand English

Safety:

• Ensure compliance with policies and procedures related to safe work practices
• Uses all appropriate equipment and/or tools to ensure workplace safety
• Immediately reports unsafe working conditions
• Follow all infection control procedures including blood-borne pathogen protocol
• Be familiar with and know locations of Safety Data Sheet Binder

Privacy/Compliance:

• Maintains privacy and security of all patient, employee, and volunteer information and access to such information. Such information is accessed on a need to know basis for business purposes only.
• Complies with all regulations regarding corporate integrity and security obligations. Reports unethical, fraudulent or unlawful behavior or activity.
• Upholds strict ethical standards.

Desirable:

Supervisory/Managerial Accountability:

Direct:

Indirect: