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Director of Compliance - PCHP

Date:  Feb 3, 2023
Location: 

Dallas, TX, US

Category:  Corporate and Professional Jobs
Job Type:  Not Applicable
Requisition ID:  900748

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

 

Primary Purpose

The Director of Compliance is responsible for managing and improving the Parkland Community Health Plan (PCHP) Compliance Program to assure compliance with State and Federal regulations for the health plan. Assists the Chief Compliance & Ethics Officer with oversight of compliance and regulatory matters and is primarily responsible for overseeing the organization’s operational areas. Serves as an internal consultant to management and staff regarding compliance with Federal and State laws and regulations, contract provisions, accreditation standards, and internal policies and procedures. The Compliance Director will implement plan-wide initiatives related to the Compliance Program and will be responsible for delegation oversight, auditing, and monitoring, and tracking corrective action plans.

 

Minimum Specifications

 

Education

  • Bachelor’s degree in healthcare administration, business administration or a related field.
  • A Master’s degree, Juris Doctorate or other advanced degree is strongly preferred.

 

Experience

  • Minimum Eight (8) years of progressive experience in a compliance leadership role in a health plan and/or managed care organization.
  • Three years of experience directly interacting with state and federal regulatory agencies (OIG, HHSC, CMS, TDI).
  • Five years of direct and indirect management experience.

 

Certification/Registration/Licensure

  • Must have, or obtain within 24 months of placement in position, one of the following certifications:
  • Certified in Healthcare Compliance (CHC)
  • Certified Compliance & Ethics Professional (CCEP)
  • Certified Compliance Professional (CCP)

 

Skills or Special Abilities

  • Excellent verbal and written communication skills that are effective with stakeholders and leaders internal and external to the organization.
  • Ability to communicate with appropriate tact and diplomacy.
  • In-depth knowledge of Centers for Medicare & Medicaid Services managed Medicare, Medicaid and TDI rules as well as other applicable laws and regulations.
  • Strong organizational and planning skills.
  • Ability to evaluate complex healthcare compliance issues and make appropriate recommendations.
  • Ability to meet strict and intense internal and governmental reporting requirements and deadlines.
  • High degree of personal integrity and commitment to best practices and ethical conduct.
  • Computer literate and proficient with Microsoft Word and Excel.
  • Highly organized with great attention to detail and accountability
  • Responds well under pressure; accepts delegation while simultaneously serving as a coach/mentor/supporter to subordinates
  • Excellent critical-thinking skills with intuitive ability to appropriately escalate matters based on potential risk to the organization.
  • Appreciation for the confidential nature of compliance-related and attorney-client privileged matters; fosters a balanced “need to know” work environment in support of Program objectives.

 

Responsibilities

  • Supports the ongoing operation and sustainability of the Health Plan from a compliance perspective, which includes conducting analysis, documenting findings, and summarizing the complexities in a manner that is easily understood, actionable and supports the Health Plan’s effectiveness. Assist in development, implementation, and ongoing assessment of an effective compliance program, including but not limited to:
  • compliance-related policies and procedures
  • formal education, training, and communications
  • compliance risk assessment program
  • annual compliance work plan and audit plan (internal and external delegates)
  • fostering a ‘speak-up’ organizational culture free from retaliation
  • Designs, implements, and improves processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and contract requirements.
  • Coordinating resources to ensure the ongoing effectiveness of the Compliance Program. Oversight and timely submission of state adhoc requests, reports, and deliverables.
  • Works on fraud, waste and abuse program including working with data analytics to identify patterns of potential fraud, waste, and abuse.
  • Serves as an organizational resource (both externally and internally) relating to health plan regulatory compliance matters. Conducts thorough research and provides prompt, courteous consultative services regarding compliance matters.
  • Assists in developing and disseminating topic-specific education to Health Plan personnel based on identified risks or changes in law or regulation.
  • Uses data analytics to develop and track Health Plan performance with regards to compliance standards. Works collaboratively with leadership to validate efficacy of the data to support compliance with legal and regulatory requirements.
  • Implements an organizational framework for monitoring the federal and state regulatory landscape related to the Health Plan and to identify new developments and changes that impact the organization. Works with leaders to communicate requirements and responsibilities.
  • Conducts on-going assessment for areas of regulatory compliance risk within the Health Plan, and, in close collaboration with Internal Audit, develops an annual compliance auditing and monitoring plan.
  • Oversees creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with contract requirements or performance deficiencies.
  • Participates in new business implementations, including the identification and tracking of required contract report deliverables and assist with readiness review assessments.

 

Job Accountabilities

  1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of the department and Parkland.
  2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
  3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
  4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
  5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of Parkland.
  6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

 

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.


Nearest Major Market: Dallas
Nearest Secondary Market: Fort Worth

Job Segment: Patient Care, Healthcare Administration, Medicaid, Medicare, Manager, Healthcare, Management