Healthcare Compliance Officer

1 week ago

Parsippany, New Jersey, United States Agadia Full time
About Agadia

We are dedicated to revolutionizing the quality of care and expediting the delivery of healthcare services by advancing and automating utilization management processes.

Role Responsibilities

The Healthcare Business Associate Compliance Officer will ensure that our compliance processes are implemented consistently and effectively across the organization. As the compliance leader and subject matter expert, this role is responsible for establishing standards and implementing procedures to ensure that our compliance programs throughout the organization are practical and efficient in identifying, preventing, detecting, and correcting noncompliance with applicable laws and regulations.

Key Responsibilities:
  • Define the necessary level of knowledge on regulatory compliance requirements across the organization.
  • Develop and periodically revise the annual compliance work plan to reflect the organization's unique characteristics and changes.
  • Oversee the implementation of the compliance program, including HIPAA Privacy and Security requirements.
  • Guide the compliance and Information Security teams professionally and productively.
  • Provide training and educational programs to enhance understanding of laws and regulatory requirements.
  • Offer strategic direction to the management team and Compliance Committee regarding the Compliance Program.
  • Prepare and present concise compliance reports to the Board Committee.
  • Interact with regulators on compliance issues as needed.
  • Coordinate audits, reviews, and examinations.
  • Develop policies that encourage reporting of suspected fraud without fear of retaliation.
  • Conduct internal compliance reviews and monitoring activities, including periodic departmental reviews.
  • Independently investigate compliance-related matters and monitor external review processes.
  • Manage investigations from the compliance hotline and report Compliance Program KPIs to the Compliance Committee.
  • Coordinate Information Security activities with the internal InfoSec Operations Manager.
  • Apply Medicare/Medicaid regulatory requirements relevant to clients and Agadia's status as a business associate.
  • Evaluate the effectiveness of the compliance program regularly.
  • Develop working relationships with clients to ensure proper compliance with CMS reporting(CDAG/ODAG/ODR/CDE).
  • Review plan policies and procedures for compliance prior to RFP document submission.
  • Support the creation and updating of monitoring metrics for ongoing compliance assessment.
  • Demonstrate in-depth knowledge of the healthcare industry, including fraud, waste, and abuse audit operations, claims handling, and payment operations.
Qualifications
  • Bachelor's Degree minimum.
  • 5+ years of experience in a Compliance leadership-related role for either a CE or another Business Associate.
  • Software programming/Information security, software security experience strongly preferred
  • Working knowledge of healthcare laws, rules, regulations and/or regulatory compliance; experience conducting legal/regulatory research preferred
  • Experience in managing government program (Medicare/Medicaid) compliance
  • Healthcare Compliance (CHC) and/or HIPAA Privacy (CHPC) certification is strongly recommended/preferred
  • Working knowledge of MS Office, Visio, MS Project, and Adobe Acrobat; Policy Tech by Navex Global experience is a plus.
Key Competencies:
  • Communicates effectively – Attentively listens to others, provides timely and helpful information, and is effective in various professional settings. Demonstrates excellent oral and written communication skills. Communicates effectively with all levels of the organization, from staff to senior leadership.
  • Being resilient. Demonstrates grace under pressure; maintains a positive attitude in the face of adversity and rebounds from setbacks.
  • Manages complexity. Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems. Has strong organizational skills and can manage multiple projects at once.
  • Ensures Accountability. Follows through on commitments and makes sure others do the same. Able to work independently and as part of a team

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