The Compliance Officer reflects the mission and vision of Cook County Health (CCH), adheres to the organization's Code of Conduct and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
The Compliance Officer is responsible for the ongoing development, implementation, maintenance, and evolution of the CCH compliance program and all related compliance activities. This includes, but is not limited to, the development and subsequent assessment of comprehensive policies and procedures, protocols, compliance training, and internal investigations.
This position is exempt from Career Service under the CCH Personnel Rules.
General Administrative Responsibilities
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure
General Administrative Responsibilities continued
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Governance of the Health Plan's Fraud, Waste, Abuse (FWA) and Financial Misconduct Program (Program Integrity Program); Special Investigations Unit; to ensure that FWA and Financial Misconduct is actively administered , as delegated by the Chief Corporate Compliance & Privacy Officer
Monitors operational management of the Health Plans' complaint, grievance, appeals and the fair hearing process received from members and care providers for program compliance in addition to trends and patterns through reports and data analysis
Collaborates with the Chief Corporate Compliance & Privacy Officer to ensure that FWA is reported in accordance with federal, state and local requirements, as well as the guidelines in the Medicaid Managed Care regulations at 42 CFR §438.608 and the CCH Managed Care Community Network (MCCN) Agreement with Healthcare Family Services (HFS)
Implements and coordinates methods and programs that encourage workforce, employees and independent contractors to report issues related to noncompliance and potential FWA without fear of retaliation
Reviews health plan agreements, contracts, addenda, and other relevant documents, as needed.
Aligns with operational management of the Health Plans' sanction/exclusion check to ensure that providers, management, workforce and independent contractors (where necessary) are screened against applicable Federal and state sanction and exclusion
Coordinates potential fraud investigations/referrals with the Special Investigations Unit (SIU), where
Collaborates with other health plans, HFS, Medicaid Fraud Control Units (MCFUs}, commercial payers, and other organizations, where appropriate, when a potential FWA issue is discovered that involves multiple
Serves in a leadership capacity to develop the system-wide compliance program in conjunction with the Chief Corporate Compliance & Privacy Officer
Collaborates with operational leadership to facilitate operational ownership of compliance
Synchronizes system-wide compliance program materials and messaging to present a uniform approach .
Oversees, directs, delivers, tracks, or ensures delivery of compliance training, both global and specialty, for employees, physicians, volunteers, students, vendors, and consultants
Develops, assesses, evaluates, implements, maintains, and updates compliance policies and procedures to ensure adherence with the requirements
Establishes a structured process for regulatory review, monitoring, and dissemination of information. Modifies policies, procedures, and projects to reflect changes in laws and regulations
Develops and coordinates compliance projects with CCH system entities as delineated in the Compliance Program Annual Work Plan and perform prospective reviews in conjunction other personnel as deemed necessary, and as determined by the Chief Corporate Compliance & Privacy Officer
Typical Duties continued
Performs system-wide interviews with all key personnel to validate compliance with established policies and procedures and applicable regulations in conjunction with other personnel, as deemed necessary
Prepares and analyzes a narrative description of the process or function under review In order to evaluate potential strengths and weaknesses and to determine the adequacy of the overall system to ensure compliance, as deemed necessary
Develop reports upon completion of each compliance review, which details recommendations designed to correct any potential weaknesses or areas of non-compliance discovered during the review
Perform Follow-Up reviews as generated by the Compliance Program Work Plan to ensure action plans have been adequately implemented
Assure that Compliance Program reports are produced for the Chief Executive Officer, Board of Directors, and/ or the Audit and Compliance Committee of the Board of Directors, as directed by the Chief Corporate Compliance & Privacy Officer
Establishes and administers a process for receiving, documenting, tracking, investigating, and taking action on all compliance concerns
Perform compliance interviews and investigate reports of alleged non-compliance to determine the validity, nature and scope of the report in conjunction with the designated team members, as identified by the Chief Corporate Compliance & Privacy Officer
Collaborates with operational areas to remediate concerns through action plans to correct potential weaknesses and assure ongoing compliance
Develop Compliance Reports during the course of the investigation and subsequent to the completion of the investigation under the auspices of the Chief Corporate Compliance & Privacy Officer, and Legal Counsel if deemed necessary
Maintains highest levels of confidentiality regarding all departmental operations - in communication both verbal and written and with the use of technology
Ability to prioritize work with minimal supervision and use time Requires high degree of follow-through despite frequent interruptions
Possess ability to work in a fast-paced environment, which requires handling multiple tasks at once
Reports to the Chief Corporate Compliance & Privacy Officer.
Master's Degree In Healthcare, Business, Education, or related field
Three (3) years of conducting complex healthcare analysis and investigations
Leadership competencies to include planning and organizing, problem solving, informing, consulting, supporting, and networking
Knowledge of coding/utilization, billing, medical records, review/analysis, and documentation
Juris Doctor (J.D.)
Professional Registration/Certification as a RN or other clinical healthcare credentials, current & active, including but not limited to RHIA, CPA, CFE, or (Must obtain CHC credentials within 6-months of hire)
Five (5+) years recent managerial/supervisory experience in a hospital or a large multi specialty clinic setting with experience in the areas of compliance, audit, risk, quality and/or legal
Knowledge, Skills, Abilities and Other Characteristics
Project Management experience and exceptional organizational skills
Extensive Report Development experience & Policy & Procedure development experience
Experience in Public Speaking and Business Presentations
Highly developed software application skills - MS Office Access, Excel, PowerPoint, and Word
Behavioral commitment to quality work and customer service philosophy
Strong communication skills - written and verbal; skilled in partnership development and conflict resolution
Strong knowledge of Microsoft Office Suite
Ability to travel to and from any CCH entity, including the Ambulatory Clinics and Cook County entities offices
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, “Typical Duties” are essential job functions.
Cook County Health is an equal opportunity employer.
Internal Number: 8103
About Cook County Health
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER