Compliance Officer, Healthcare

Description

The Compliance is responsible for ensuring Telos maintains full compliance with State of Utah licensing requirements, Joint Commission standards, and the requirements of Medicaid and third-party insurance payors across all campuses. This role oversees clinical documentation quality, critical incident management, staff training and accountability, payor and insurance compliance, facility safety and risk mitigation, and organizational readiness for regulatory inspections.

• Conduct regular chart reviews to audit clinical documentation for charting compliance.
• Perform clinical hours audits to verify clients are receiving 20 hours per week..
• Review charting quality for proper clinical language, terminology, and completeness.
• Train clinical and direct-care staff on documentation standards, charting expectations, and correct clinical language.
• Partner with Bridgeway Billing to train staff on documentation practices that support accurate, compliant billing.
• Monitor level of care changes and update client charts to reflect the new level of care.

• Submit critical incident reports to the State of Utah in accordance within 1 business day.
• Assist in CPS and law enforcement reporting when needed.
• Review each critical incident to determine root cause and identify which incidents were preventable by staff action or inaction.
• Develop and implement corrective action plans and additional targeted training following preventable incidents.
• Pull and review camera footage related to incidents and use it as a training tool with staff.
• Track incident trends over time and report findings to leadership.

• Partner with Human Resources to address and discipline staff for compliance violations.
• Ensure quality documented training is being delivered consistently and effectively across all campuses.
• Design and facilitate engaging, effective additional trainings on compliance, safety, and clinical topics.
• Train staff on Policies & Procedures (P&P) and ensure understanding of expectations.

• Maintain thorough, current knowledge of State of Utah licensing requirements applicable to the facility.
• Ensure ongoing organizational compliance with State of Utah licensing standards.
• Ensure ongoing compliance with Joint Commission accreditation standards.
• Serve as primary point of contact for all state announced and unannounced visits, surveys, and inspections.
• Manage licensing renewals and resubmissions to ensure no lapse in licensure.
• Monitor regulatory changes at the state and accreditation level and update internal practices accordingly.

• Ensure ongoing compliance with the requirements of Medicaid and all third-party insurance payors.
• Maintain and manage insurance credentialing for the facility and clinical staff.
• Respond to and manage insurance recoupment requests, including coordinating supporting documentation and appeals.
• Lead and response to payor-initiated quality of care investigations.
• Track and respond to payor audits and chart/record requests.
• Assure short-notice peer-to-peer calls happen.

• Conduct building safety walk-throughs to identify and address hazards.
• Document risk mitigation efforts and maintain risk management records for the facility.
• Walk the building weekly to identify maintenance issues and cleanliness concerns.
• Create and manage systems of accountability for cleanliness across the facility.
• Hold maintenance staff accountable for the overall condition of the building.
• Oversee and manage custodial operations.
• Identify areas of the building in need of remodeling, cosmetic updates, or improved decor, and lead efforts to make those spaces more attractive and welcoming.

• Maintain and organize all critical compliance documents, including fire inspection reports, business license renewals, and county health certificates.
• Handle legal issues in conjunction with company attorneys.
• Lead development and ongoing maintenance of the…