Community Care Health Network, LLC d/b/a Matrix Medical Network (Matrix) seeks an experienced candidate to join our corporate Legal Department to support our growing business. Reporting to the General Counsel and Chief Compliance Officer, this individual will lead Matrix’s corporate Compliance Programs, including, but not limited to, the development of policies and procedures; compliance audits; monitoring and investigation of compliance incidents. This role includes interaction with management, employees and customers, and the institution of remediation activities; overseeing and monitoring required and other training across the enterprise; research of applicable regulations, including laws governing data privacy, clinical licensing and credentialing, and nurse collaboration activities; preparing, drafting, reviewing and negotiating Business Associate Agreements (BAAs), Non-Disclosure Agreements (NDAs), Delegation Agreements and other contracts. The successful candidate will also work directly with other members of the Legal and Compliance Department to provide general advice, guidance and counsel on a variety of legal and compliance issues. The focus of this role is to continually explore opportunities to better shape the compliance program at Matrix. Success in this role will be driving our compliance program to the next level.
Executive Leadership, Clinical Services, Credentialing, Human Resources, Quality Operations, external customers and external vendors.
- Develop, initiate, maintain, and revise policies and procedures for the general operation of the Compliance Program and related activities to prevent illegal, unethical, or improper conduct. Manage day-to-day operation of the program.
- Responsible for development and implementation of the Matrix Corporate Compliance Program.
- Foster a culture of integrity, ethics and compliance.
- Proactively identify potential areas of compliance vulnerability and risk; develop/implement corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
- Establish and provide direction and management of the Compliance Hotline.
- Institute and maintain an effective compliance communication program for the organization, including promoting the use of the Compliance Hotline, creating heightened awareness of Code of Conduct, and understanding of new and existing compliance issues and related policies and procedures.
- Work 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.
- Provide ongoing awareness of Centers for Medicare and Medicaid Services (CMS), Healthcare Integrity Portability and Accountability Act (HIPAA), HITRUST Common Security Framework (HITRUST), and relevant state regulations governing the protection, use and disclosure of confidential information Matrix creates, receives, or has access to.
- Review Business Associate Agreement (BAA) forms for compliance within regulatory requirements; assist attorneys as a resource in the negotiation of BAAs.
- Consult with Credentialing to provide guidance concerning National Committee of Quality Assurance (NCQA) requirements, Centers for Medicare and Medicaid Services (CMS) rules, internal company policies, and Customer requirements.
- Create compliance training modules; assist Human Resources in ensuring all personnel, including employees, temporary staff, and subcontractors, receive pre-hire/pre-contracting and annual compliance training.
- Provide consultation related to the Matrix Collaborating/Supervising Physician program, including review of statutes and legal requirements, and recommendations to the business for implementation and revision of requirements.
- Review Medicare and Medicaid provider enrollment requirements for groups, providers, mobile units, and provide collaboration to the business on statutory requirements and priorities.
- Develop contractual provisions and amendments relating to compliance requirements to be incorporated into vendor, subcontractor, temporary agency, and other contracts entered into by Matrix.
- Monitor and enforce Matrix personnel and subcontractors’ compliance with data protection policies.
- Update the Company’s procedures for employee reporting of alleged data protection incidents.
- Manage annual compliance audits of the Organization and its subcontractors/vendors.
- Prepare and analyze reports concerning issues, audits, investigations, monitoring efforts, and other relevant compliance matters.
- Ensure the Organization has the correct policies and practices in place to meet appropriate document retentionobligations.
- Investigate and report out on potential compliance violation(s).
- Perform other duties as assigned.
- Bachelor’s in Business, Finance, Health Care or related field
- Master’s degreepreferred
- Certification in Healthcare Compliance (CHC) is a plus
Required Skills and Abilities:
- Minimum of five (5) years of healthcare experience, focused on healthcare compliance andhealthcare industry regulation, including Medicare/Medicaid regulations and HIPAA compliance
- In-depth knowledge of federal and state healthcare regulations and compliance requirements
- Experience in audit and risk management
- Demonstrated leadership skills
- Experience in policy formulation and implementation
- Strong consultative and analytical skills
- Excellent interpersonal, presentation, written and verbal communication skills
- Strong client and vendor relations skills
- Ability to interact successfully with senior leaders, both internal and external to the organization
- Strong work ethic with a “can do” attitude; self-starter, quick study and ability to manage deadlines
- Executive presence and strong interpersonal skills and experience interfacing with a wide variety of key stakeholders; a strong collaborator and team oriented
- May include supervisory responsibilities of Compliance professionals.
- Occasionaltravel may be required.
- General office environment.
The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of the position.