|Program:||Fallon Tribal Health Center||Salary Grade:||GS – 17|
|Supervisor:||Health Director||Salary Range:||$26.04 – $39.39|
|FLSA Status:||Exempt Non-Exempt Public Safety||Position Type:||Choose an item.|
This position is responsible for planning, designing, implementing and maintaining FTHC-wide compliance and audit programs; establishing policies and procedures designed to promote a corporate culture that foster ethical and compliant behavior and provide the basis for ensuring adequate internal controls and compliance with all laws, regulatory or contractual requirements applicable to FTHC, as well as FTHC’s internal policies.
ESSENTIAL DUTIES & RESPONSIBILITIES
- Develops an annual compliance plan and objectives pursuant to FTHC’s Compliance Plan.
- Develops, administers and monitors implementation of a FTHC-wide plan to comply with state, federal and accreditation requirements, including but not limited to requirements of Medicaid, Medicare, Joint Commission, HIPAA, CLIA and OSHA.
- Develops, maintains and revises policies and procedures for the general operation of the FTHC’s Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
- Ensures that compliance and HIPAA training for FTHC is developed, implemented, and provided on a regular basis.
- Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future.
- Ensures monitoring of billing and reimbursement in order to ensure business practices are in accordance with guidance from Medicare, Medicaid, and the Department of Health and Human Services Office of the Inspector General (OIG).
- Conducts internal monitoring in order to ensure business practices are in accordance with applicable laws and regulations as well as FTHC policies.
- Provides written reports on a regular basis to the Health Director and FTHC Management Team of the operation and progress of compliance efforts.
- Ensures excluded and/or debarred party screening are completed for FTHC consultants, contractors, and vendors, pursuant to FPST/FTHC policy, federal regulations, and OIG guidance.
- Exercises day to day responsibility in the oversight of HIPAA compliance; acts as HIPAA Privacy Officer.
- Maintains a reliable compliance tracking system and reports status of compliance issues.
- Works with the Health Director, FTHC Management Team, and others as appropriate to develop effective compliance and HIPAA training program.
- Provides up to date information relating to Notice of Privacy Practices Information and Business Associate Agreements.
- Serves as resource to FTHC on healthcare laws, regulations, internal auditing procedures and standards including HIPAA.
- Ensures Business Associates have been identified and Business Associate Agreements are in place. Periodically monitors all contracts, consultant agreements and vendor agreements to ensure Business Associates are appropriately identified.
- Conducts regular internal compliance audits for billable entities of the FTHC.
- Maintains and updates the FTHC Compliance Plan and conducts quarterly Compliance Committee meetings to ensure communication of compliance efforts are relayed to all levels of the FTHC.
- In coordination with the Health Director, assists with an annual independent audits of billing/coding activities of the FTHC.
- Conducts periodic internal reviews/assessments of activities, relevance of job functions to the level of access to Personal Health Information (PHI), and the physical and technical security of PHI;
- Ensures that contracts and agreements are compliant with HIPAA and consistent with the Minimum Necessary Standards, and all other relevant departmental polices;
- Reports audit results, compliance efforts, and any other applicable activity to the Compliance Committee or other entities as directed.
- Performs other job related duties as assigned by the supervisor.
KNOWLEDGE, SKILLS & ABILITIES
- Must have knowledge of federal and state regulations related to health services, confidentiality, privacy regulations and fraud/abuse laws.
- Must have in depth knowledge of Office for Civil Rights regulations pertaining to HIPAA Privacy and Medicare, Medicaid, and private health insurances.
- Have working knowledge with OIG guidance and expectations of entities that accept funding from/through the U.S. Department of Health & Human Services.
- Skill in verbal and written communication, including the ability to communicate legal information to non-technical/legal staff, business associate, or general public;
- Skill in the development of processes, procedures, and workflows.
- Ability to interpret and apply complex State, Federal, and private rules and regulations pertaining to healthcare;
- Ability to translate intent of regulations into written policies and procedures applicable to the Department’s functions and compliant with associated regulations;
- Ability to make clear, concise, and technically accurate presentations to large groups;
- Ability to demonstrate diplomacy with staff, vendors, and business associates when performing audits and providing critical feedback or information;
- Ability to use small office equipment, computers, and highly technical computer applications.
(To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions)
- Bachelor’s degree in Business or Health Administration; AND
Three (3) years of responsible technical, professional, and administrative functions in public administration, regulatory compliance, health services, or a related field that includes four (4) years with an entity regulated under HIPAA, Medicare, and Medicaid.
- Certified in Healthcare Compliance (CHC) through Health Care Compliance Association preferred.
- Certification in Healthcare Privacy and Security (CHPS) through the American Health Information Management Association (AHIMA) or Certification in Healthcare Privacy Compliance (CHPC) through the Health Care Compliance Association strongly preferred.
Fallon Paiute-Shoshone Tribe and Native American/Indian Preference: Employment preferences to members of the Fallon Paiute-Shoshone and to members of federally-recognized Indian Tribes shall apply to this position pursuant to the Tribe’s Personnel Policies. Persons of Tribe and/or Indian ancestry and wish to claim these employment preferences should submit a copy of the Tribal Enrollment Card/Certification indicating the name of the Tribe they are enrolled with.
U.S. Veteran’s Preference: Preference to opportunities to veterans honorably discharged from the United States Armed Forces shall apply to this position pursuant to the Tribe’s Personnel Policies.
Equal Opportunity Employer: The Fallon Paiute-Shoshone Tribe does not discriminate on the basis of race, color, national original, sex, religious preference, age, handicap, marital status, political preference, genetics or membership or non-membership in any employee organization, except as allowed by Federal and/or Tribal Law.
Drug Free Workplace: The Fallon Paiute-Shoshone Tribe is a drug-free workplace. All employees are subject to a pre-employment and random drug screens.
Driving Record: Employees who drive tribal vehicles must have a valid Nevada Driver’s License, be insurable under the Tribe’s vehicle insurance program, and must also provide a DMV printout annually.
Background Checks: All employees must be able to pass a background check per the Tribe’s Background Check Policy.
Position Description Limitations: This position description does not constitute an employment agreement between the Tribe and the employee, and is subject to change by the Council as the needs of the Tribe and the requirements of the job change. This position description is not intended to present a descriptive list of the range of duties performed by any employee in this position and is not intended to reflect all duties performed within the position.