Position Summary
The ChiefCompliance and Quality Officer (CCQO) provides executive leadership andoversight of the organization's Corporate Compliance Program, Risk ManagementProgram, quality reporting activities, and regulatory readiness efforts. Thisposition ensures compliance with applicable federal, state, local, HRSA, HIPAA,Medicare, Medicaid, and FQHC regulations while supporting organizationalperformance through quality measures, regulatory standards, and patient safetyinitiatives.
As a member ofthe Executive Leadership Team, the CCQO collaborates with clinical,operational, financial, human resources, and information technology leadershipto foster a culture of compliance, accountability, patient safety, andoperational excellence.
Essential Duties andResponsibilities
• Direct, implement, monitor, and evaluate theorganization's Corporate Compliance Program.
• Ensure compliance with applicable federal,state, and local healthcare regulations, including HRSA requirements, HIPAA,Medicare, Medicaid, OSHA, and OIG guidance.
• Develop and maintain compliance policies,procedures, standards, and the organization's Code of Conduct.
• Develop and manage the annual Compliance WorkPlan and conduct ongoing compliance risk assessments.
• Conduct compliance audits and investigations toidentify areas of risk, non-compliance, or operational vulnerability.
• Develop and monitor corrective action plans toensure timely resolution of identified compliance issues.
• Oversee contract compliance, business associateagreements, conflict-of-interest requirements, and applicable Stark Law,Anti-Kickback Statute, and False Claims Act requirements.
• Coordinate exclusion screening of employees,contractors, vendors, and Board members against applicable federal databases.
• Manage confidential compliance reportingmechanisms and serve as liaison with regulatory agencies, auditors, legalcounsel, and external consultants as needed.
Quality Reporting and PerformanceMonitoring
• Monitor, analyze, and report organizationalquality metrics and performance indicators.
• Track UDS, HEDIS, CMS, value-based care, andother regulatory or payer-required quality measures.
• Ensure the accuracy, integrity, validation, andtimely submission of required quality reports.
• Conduct chart reviews, audits, and data analysisto identify compliance, quality, and performance trends.
• Provide leadership with actionable reports anddashboards to support clinical and operational decision-making.
• Collaborate with department leaders to addressperformance variances, regulatory requirements, and opportunities forcontinuous improvement.
Education & Experience
• Bachelor's degree in Informatics, HealthInformatics, Data Science, Data Analytics, Healthcare Administration, BusinessAdministration, Compliance, Quality Management, or a related field required;Master's degree preferred.
• Minimum of five (5) years of progressivehealthcare compliance, quality, risk management, or related leadershipexperience preferred.
• Experience within a Federally Qualified HealthCenter (FQHC), community health center, or similar healthcare environmentstrongly preferred.
• Demonstrated knowledge of medical billing,coding, documentation requirements, revenue cycle operations, and payerregulations required.
• Experience conducting coding and billingcompliance audits and ensuring compliance with ICD-10-CM, CPT, HCPCS, Medicare,Medicaid, and commercial payer guidelines required.
• Experience developing and providing complianceand regulatory education to staff, providers, management, and Board memberspreferred.
Knowledge,Skills, and Abilities
• Strong knowledge of healthcare compliance, riskmanagement, quality improvement, patient safety, and regulatory requirements.
• Knowledge of HRSA, FQHC, HIPAA, OIG, Medicare,Medicaid, and other applicable healthcare regulations.
• Strong leadership, analytical, auditing,investigation, and problem-solving skills.
• Excellent written and verbal communicationskills with the ability to communicate regulatory and compliance requirementsacross all levels of the organization.
• Ability to maintain confidentiality, exercisesound judgment, and handle sensitive compliance matters with professionalismand discretion.
• Ability to analyze quality and compliance dataand translate findings into actionable organizational improvements.
