The Lead Compliance Officer implements the PHHS Compliance Program, which functions as an independent and objective body that reviews and evaluates compliance issues/concerns within the organization. The position reports to the Secretary of Public Health and Human Services (PHHS) and ensures that management and employees are in compliance with the rules and regulations of regulatory agencies, that Tribal and Divisional policies and procedures are being followed, and that behavior in the organization meets the Tribe’s and Division’s Standards of Conduct. This position plans, reviews, and develops budgets related to the Regulatory and Compliance Department. This position also will provide daily supervision of employees within the Regulatory and Compliance Department of PHHS. This position monitors and reports results of the compliance/ethics efforts of the organization to the Secretary of PHHS and provides guidance to the senior management team, as delegated, on matters relating to compliance. The Lead Compliance Officer and the Regulatory team will work together with the EBCI Office of Internal Audit and the EBCI Risk Management Department as authorized to implement all necessary actions to ensure the achievement of the objectives of an effective compliance program.
- Provides daily supervision to employees of Regulatory & Compliance.
- Plans, reviews, and develops budgets related to all programs within the Regulatory and Compliance Department of the PHHS Division.
- Develops an annual Compliance Work Plan with the Regulatory team to present to the Secretary of PHHS, the Compliance Committee Members and at times the Health Care Board of EBCI for approval.
- Performs careful review of programs/assignments to develop audit tools to ensure compliance with standards/regulations; makes adjustments or reassigns staff based on mandates/priorities.
- Oversees use of data analytics for purposes of stratification of risk management and targeting audits and reviews for such areas.
- Develops, initiates, maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct as designated by the Secretary of PHHS and the Compliance Committee members.
- Develops and periodically reviews and updates the PHHS code of conduct to ensure continuing currency and relevance in providing guidance to management and employees.
- Consults with the Attorney General’s Office as needed to resolve difficult legal compliance issues.
- Responds to alleged violations of rules, regulations, policies, and procedures, and the code of conduct by evaluating or recommending the initiation of investigative procedures.
- Develops and oversees a system for uniform handling of such violations. Acts as an independent review and evaluation body to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated, and resolved.
- Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends.
- Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations in the future.
- Monitors and takes appropriate measures to ensure PHHS is not doing business with any individual or entity that has been sanctioned, debarred, or otherwise excluded from participation in Federal or State funded health care programs.
- Conducts annual compliance audits for billable entities of the PHHS Division.
- Maintains and updates the PHHS compliance plans in accordance with the Office of Inspector General’s recommendations.
- Co-chairs and facilitates the quarterly Compliance Committee meetings to ensure communication of compliance efforts are relayed to all levels of the division.
- Maintains confidentiality and adheres to HIPAA and the HITECH Act and the Omnibus law and regulations.
- Conducts privacy and security investigations to ensure no Federal regulations have been violated.
- Provides reports on a regular basis, and as directed or requested, to keep the senior management informed of the operation and progress of compliance efforts.
- Ensures proper reporting of violations or potential violations to duly authorized enforcement agencies as appropriate and/or required.
- Establishes and provides direction and management of the compliance Hotline. Institutes and maintains an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline; (b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures.
- Works with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees and managers.
- Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness.
- Develops goals and objectives aligned with PHHS mission, vison, and values using Results Based Accountability (RBA).
- Provides assistance as requested to respective program management staff in defining and resolving service delivery problems.
- Serves as liaison with State Centers for Medicaid and Medicare (CMS), Federal funding offices, and EBCI Office of Internal Audit.
- In the event of a Public Health Emergency, may be reassigned duties as necessary.
- Ensures the basic licensing process for foster care homes is completed, to include receiving and responding to pre-application inquiries, reviewing background checks, and reviewing fire, safety, and environmental evaluations.
- Ensures periodic on-site assessments of the provisionally or fully licensed homes are completed by the Regulatory team, no less than annually.
- Processes waiver requests, documents any findings during on-site visits, and formulates recommendations, denial/revocation requirements, or injunctive actions.
- Enters each new applicant into the Regulatory and Compliance Foster Care Licensure Tracker/Spreadsheet and monitors when on-site visits are due, re-licensure is due, etc.
- Cooperates with other specialists and regulatory agencies, such as fire marshals, building inspectors, sanitarians, teachers, public health nurses, the Office of the Attorney General and any other Divisions of the Executive Branch as required.
- Provides quality assurance and approval of foster parent medical documentation.
- Creates and signs off on provisional licensure (up to six (6) months) and full licensure certificates which designate who the foster family is, where it is located, the date it is licensed and how many children can receive foster care in the home (at that specific address).
- Oversees the childcare facility licensure process as mandated by Tribal Code.
- Creates, reviews, and updates Tribal laws and regulations when necessary to facilitate program operations in conjunction with the Office of the Attorney General.
This position is supervised by program leadership. This position is responsible for supervising assigned personnel.
Experience: Four (4) years of related experience required. Experience in a health or human service organization, to include demonstrated experience with performing compliance audits related to State, Tribal, and Federal guidelines.
Education: Master’s Degree in related field required.
Licenses & Certifications: Valid, insurable NC Driver’s License required. Must have CPR/First Aid certification. Must meet Public Health Core Competency Domains within 12 months of employment.
* Disclaimer Statement
This is not intended to be an all-inclusive list of job-related responsibilities, duties, skills, requirements or working conditions. Other duties may be assigned based on business need and the supervisor’s request.
EBCI reserves the right to revise the position description at any time. Designated positions may be required to assist in emergency and/or disaster situations. Complete job description is found on application site.
PHHS
16 Exempt
ALL JOB POSTINGS CLOSE AT 11:59PM EST ON THE CLOSE DATE.
