DESCRIPTION
|
Under general direction, the designated program Compliance and Privacy Officer (CPO) plans, organizes, directs, monitors, and promotes an effective compliance and privacy program. This position ensures that departmental compliance programs are consistent with the Health Care Services Agency’s (HCSA) Standards of Conduct and core values, policies and procedures, and promote adherence to applicable federal and state laws to advance the prevention of healthcare fraud, waste, and abuse, while providing quality care and services to those served by HCSA; oversee all ongoing activities related to the development, implementation, maintenance, and adherence to HCSA’s policies and procedures covering the privacy of and access to protected health information (PHI) in compliance with applicable state and federal laws; and performs other related work as required.
DISTINGUISHING FEATURES
This classification is located in the HCSA and reports to the Chief Compliance and Privacy Officer and is responsible for the broad coordination of the Department’s comprehensive healthcare compliance and privacy assurance program. The incumbent is responsible for coordinating and performing activities related to education, training, auditing, and investigations to ensure employee awareness and compliance with the program and may serve as project manager overseeing the development, implementation, and maintenance of related programs. This classification is distinguished from the Quality Assurance Administrator classification which has primary responsibility for day-to-day operational issues focused on the appropriate and effective delivery of services to clients whereby this classification is focused on broader departmental-wide compliance activities.
|
EXAMPLES OF DUTIES
|
NOTE: The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.
- Implements and oversees the compliance and privacy programs at the entity or departmental level to ensure the program meets the state/federal requirements and is aligned with the HCSA Office of Compliance Services.
- Acts as a consultative resource for the entity leadership and associates on compliance and privacy matters. Provides overall leadership on issues concerning compliance and privacy, including developing and implementing controls designed to ensure compliance with applicable laws, rules and regulations, and detect and deter fraud, waste, and abuse.
- Assist with the development and implementation of compliance and HIPAA privacy policies and procedures.
- Ensures the implementation and maintenance of an effective healthcare compliance and privacy program for the entity which will include conducting relevant risk assessments and developing risk-based compliance work plans.
- Maximize current strengths of the healthcare compliance and privacy program, identify and remedy gaps, proactively assess and address emerging compliance risks.
- Drive and advance compliance monitoring activities, including compliance auditing in the areas of coding and billing, and privacy audits. Develop appropriate analytics to analyze the Department’s compliance to applicable regulations and internal policies.
- Oversees the implementation of corrective actions and monitoring in response to identified issues, audits, and annual work plan items.
- Independently investigates or supervises the investigation of compliance or privacy concerns raised through the Agency Helpline or other reporting mechanisms.
- Ensures distribution, implementation, and education regarding compliance policies and procedures, fraud waste and abuse, conflict of interest, code of conduct, billing and documentation, HIPAA privacy, and security awareness training.
- Participates in the development and implementation of annual work plan, enterprise risk assessment, and management and aligns entity risk assessment with the Agency risk management plans.
- Chairs or co-chairs the entity compliance and privacy committees and reports to the entity and Agency level leadership on compliance matters and progress on a regularly established frequency.
- Maintains knowledge of rules and regulations (healthcare compliance, HIPAA, HITECH, state privacy laws, etc.) that impact specific service areas and the organization and acts as a subject matter expert to support and provide guidance to workforce members.
- Develops and maintains collaborative relationships with leaders and stakeholders across the organization.
- Identifies opportunities and supports efforts to build a culture of compliance.
- Performs other duties as assigned.
|
MINIMUM QUALIFICATIONS
|
Education:
Possession of a bachelor's degree in public health, health care administration, social work, business administration, public administration, nursing, or a related field.
AND
Experience:
The equivalent of four (4) years of responsible, professional-level healthcare compliance and recent experience in one or more of the following areas in a healthcare delivery setting consisting of community health clinics, hospitals, skilled nursing facilities, physician practices, health insurance plans, or other healthcare settings with a focus on regulatory compliance, quality assurance, health care law and/or administration, risk management and/or regulatory investigations.
Substitution:
A master's degree in public health, health care administration, social work, business/public administration, law, nursing, or a related field may be substituted for one (1) year of the required experience.
License/Certification: Possession of a valid California Motor Vehicle Operator’s license. Possession of a Healthcare Compliance Certificate issued by the Healthcare Compliance Association’s Certification Board is required within six (6) months of hire date.
NOTE: The Civil Service Commission may modify the Minimum Qualifications in the announcement of an examination.
|
KNOWLEDGE AND SKILLS
|
NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the “Examples of Duties” section of this specification.
Knowledge of:
- Public administration principles and practices, including strategic planning, program development, implementation and evaluation, and management in a public setting.
- Privacy and compliance best practices, clinical operations, and patient care workflow.
- Medicaid/Medicare regulations and rules.
- Effective compliance program management as defined by current industry standards and benchmarks relationship to plan management and health care delivery, including strategy, business planning, operations, and finance.
- Behavioral Health management, policy, and system design.
- Federal, State, and local regulations as they relate to behavioral health care services, including quality assurance practices, privacy standards, and HIPAA compliance regulations.
- Federal and State health care laws and regulations, including Medicare and Medi-Cal, third-party payers, Stark and Anti-kickback statutes, and requirements, Health Information Technology for Economic and Clinical Health (HITECH), HIPAA, and state privacy rules and regulations, and other rules that pertain to business associates.
- Privacy and compliance best practices, clinical operations, and patient care workflow and ability to implement in a managed care setting and improve upon industry best practices.
- Medicaid/Medicare rules and laws, as well as all elements of an effective compliance program as defined by current industry standards and benchmarks in relationship to practice plan management and health care delivery, including strategy, business planning, operations, and finance.
- Federal and state health care laws and regulations, including Medicare and Medi-Cal, third-party payers, Stark and Anti-kickback statutes and requirements, HITECH, HIPAA, and state privacy rules and regulations and other rules that pertain to business associates.
- Practices, procedures, and legislation governing the maintenance, storage, dissemination, and safeguarding of private, health-related information.
- Interviewing and investigative techniques.
- Research methods and techniques.
- Records management principles and practices.
- Computer applications related to the work.
Ability to:
- Compile, analyze, and evaluate information and information security controls for efficiency and cost-effectiveness.
- Implement privacy and compliance measures in a managed care setting and improve upon industry best practices.
- Solve problems, including problem identification, research, and analysis of alternatives, drawing conclusions, and making recommendations.
- Perform basic mathematical calculations and produce statistical reports and data analysis as required.
- Interpret, apply, and explain laws, rules, regulations, policies, and procedures.
- Use sound, independent judgment within general policy guidelines.
- Organize work, coordinate multiple projects, and meet critical deadlines.
- Prepare clear, concise, and accurate reports, correspondence, policies, procedures, and other written materials.
- Use computer applications effectively, including word processing, spreadsheets, and basic graphics.
- Employ critical thinking skills in planning and problem-solving.
- Establish and maintain effective working relationships with co-workers, clients, customers, and representatives of other agencies or departments.
- Demonstrate and set high standards of behavior, performance, quality, credibility, and integrity.
- Communicate effectively both verbally and in writing.
|
CLASS SPEC HISTORY
|
Newspecs: 5095
NLB:cs 10/31/14
CSC Date: 11/12/14
NLB:sa Revised/Retitled 09/03/2021
Old Title: Compliance Officer, Behavioral Health Care Services
CSC Date: 09/22/2021
IL:sa Revised 05/18/2022
CSC Date: 06/01/2022
IL:saa Revised 09/25/2023
CSC Date:11/15/2023
|
BENEFITS
|
Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being. These benefits include but are not limited to*:
For your Health & Well-Being
- Medical – HMO & PPO Plans
- Dental – HMO & PPO Plans
- Vision or Vision Reimbursement
- Share the Savings
- Basic Life Insurance
- Supplemental Life Insurance (with optional dependent coverage for eligible employees)
- Accidental Death and Dismemberment Insurance
- County Allowance Credit
- Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance
- Short-Term Disability Insurance
- Long-Term Disability Insurance
- Voluntary Benefits - Accident Insurance, Critical Illness, Hospital Indemnity and Legal Services
- Employee Assistance Program
For your Financial Future
- Retirement Plan - (Defined Benefit Pension Plan)
- Deferred Compensation Plan (457 Plan or Roth Plan)
For your Work/Life Balance
- 12 paid holidays
- Floating Holidays
- Vacation and sick leave accrual
- Vacation purchase program
- Management Paid Leave**
- Catastrophic Sick Leave
- Pet Insurance
- Commuter Benefits Program
- Guaranteed Ride Home
- Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
- Employee Discount Program (e.g. theme parks, cell phone, etc.)
- Child Care Resources
- 1st United Services Credit Union
*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a brief summary of the benefits offered and can be subject to change.
** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.
|
Notify Me when a Job Opens for the above position(s)