1. Develops, maintains, and revises policies and procedures for the general operation of Compliance Program and its related activities to prevent illegal, unethical, or improper conduct and encourage managers and employees to report suspected violations. Manages day-to-day operations of the Compliance Program.
2. Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.
3. Develops and periodically reviews the Standards of Conduct to ensure continuing currency and relevance in providing guidance to management and employees.
4. Establishes and provides direction and management of the Compliance Hotline.
5. Institutes and maintains and effective Compliance Communication Program for the organization, including promoting (a) use of Compliance Hotline (b) heightened awareness of Standards of Conduct (c) understanding of new and existing compliance issues and related policies and procedures.
6. Works with the HR Department and others as appropriate to develop an effective Compliance Training Program, including appropriate induction training for new employees as well as ongoing training for all employees and managers.
7. Collaborates with other departments (eg., Risk Management, Internal Audit, HR, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with Legal Department as needed to resolve difficult legal compliance issues.
8. Responds to alleged violation of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending investigative procedures. Develops and oversees a system for unifiorm handling of such violations.
9. Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, and resolved.
10. Monitors and coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
11.a. Identifies potential areas of compliance vulnerability and risk
b. Develops & implements corrective action plans for resolution of problematic issues
c. Provides general guidance on how to avoid or deal with similar situations in the future.
12. Maintains Incident Reports and Incident Report Logs and other compliance reports on a regular basis or as directed/requested, to keep the Corporate Compliance Committee of the Board and senior management informed of the operation and progress of compliance efforts.
13. Monitors external audit review processes and responds to administrative inquiries related to Compliance issues or audits.
14. Maintains current knowledge of law and regulations, keeping abreast of recent changes.
(i) A minimum of 5 years in Healthcare outsourcing industry.
(ii) Familiarity with Healthcare outsourcing operations, quality assurance, finance, & HR procedures and regulations.
(iii) Compliance Officer profile experience of 2 years.
(iv) Working knowledge and experience of HIPAA regulations.
(v) Knowledge of SSAE & other applicable Company/Establishment Law regulations.
(vi) Excellent written and verbal communication skills.
RecordFlow
RecordFlow is an emerging industry leader who is focused on providing best in class, cost effective solutions for our customers. Founded in 2005, our team"s expertise and strong focus on operational excellence allow our clients the confidence to focus on their core business while knowing that their project is getting done right, the first time. We partner with healthcare plans to complete various risk adjustment and quality improvement programs.
RecordFlow utilizes experienced industry professionals, robust technology, and flexibility to provide high quality results for our clients. With our worldwide employee base, our clients are able to take advantage of our onshore and offshore capabilities to aid them in achieving their objectives without compromising quality and compliance. We pride ourselves on being a high quality, low cost solution to health plans across the nation.
Website: www.recordflow.com
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