Compliance Officer, Healthcare

Position

Compliance Officer — Tohono O'odham Nation Health Care

The Compliance Officer promotes the Tohono O'odham Nation Health Care's culture that encourages ethical conduct and commitment to compliance and ensures due diligence to prevent and detect illegal conduct. The work involves investigation and analysis of a variety of compliance issues throughout the Nation's hospital and clinics.

Investigate and analyze projected for proposed and existing TONHC programs for efficiency, effectiveness, and compliance with regulatory and legal requirements. Develop internal controls that adequately measure and manage risks and include standards and procedures to reduce the prospect of criminal conduct. The incumbent reports to the Quality Assurance Officer within the Quality Management Division.

• Oversee TONHC compliance and integrity using the TONHC Compliance Plan, Federal Sentencing Guidelines, and the Office of Inspector General (OIG) Program guides.
• Recommend Compliance Program revisions to meet changing organizational needs, business and regulatory environments to improve effectiveness.
• Provide compliance information to help TONHC management improve decision making, quality, and reduce vulnerability to fraud, waste, and abuse.
• Ensure independent contractors and agents who provide medical services are educated and aware of the TONHC Compliance Plan.
• Research and assist in applying regulatory compliance requirements.
• Collaborate with the Chief Legal Officer (CLO) on investigations that may require reporting to the OIG or other agencies.
• Conduct investigations of alleged violations of law, standards of conduct, or other system policies.
• Respond to employee reports (phone, email, interoffice mail) and ensure reports remain anonymous or confidential to the extent possible.
• Implement and maintain a coordinated regulatory compliance program meeting Tribal, State, and Federal regulator expectations.
• Stay current on Federal Guidelines related to meaningful use and EHR certification; develop tools to monitor and report high-risk areas identified in audits for TONHC.
• Chair the compliance committee and develop agendas and reports as requested by the CEO and Governing Body.
• Manage the compliance department's administration, including organizing files, preparing reports, and reporting to TONHC committees.
• Coordinate resources to ensure ongoing effectiveness of the compliance program and ensure alignment with other departments (Revenue Enhancement, HR, IT, Clinical Services).
• Report to the TONHC Quality Assurance Officer and keep the CEO and Governing Body apprised of compliance matters.

• Communicate the importance of compliance to senior management and staff; promote the compliance hotline and awareness of integrity and policy requirements.
• Conduct training for new and existing employees on compliance; present at new staff orientation and other forums; maintain attendance documentation.
• Develop and maintain relationships with supervisors, regulators, and external parties.
• Provide leadership to ensure regulatory information is accessible to leadership and staff, enabling compliant and ethical actions.
• Establish open lines of communication and a non-retaliation culture.
• Develop and present quarterly compliance reports to Senior Management.

• Conduct periodic reviews to assess adherence to the TONHC compliance plan and ensure proper record-keeping.
• Address issues found in audits with actions such as training and plan revisions, with follow-up to ensure effectiveness.
• Coordinate audits with Third Party Billing, Finance, HIM, and providers; focus on billing processes per organizational policies.
• Review audits with Senior Management and take prompt corrective actions for deviations, including fraud or system issues.
• Ensure corrective actions are implemented in response to external surveys or audits.
• Coordinate audits in areas such as claims denial, privacy breaches, licensure, referral practices, and standards of care.
• Coordinate investigations with CLO for major violations or oversee…