Aultman Health Foundation

PURPOSE OF POSITION:

The Corporate Compliance Officer serves as the focal point for all of AultCare’s compliance activities. The Corporate Compliance Officer monitors and communicates all compliance and FWA activities and programs with leadership and the Audit Committee of the Board of Directors. This position serves as the leader of the Compliance and FWA departments and designs, develops, implements and evaluates the commercial compliance program. The Corporate Compliance Officer will monitor and revise the commercial compliance program, as appropriate, in response to regulatory and organizational needs.

The Corporate Compliance Officer organizes training for all AultCare colleagues as required by regulatory and contractual requirements and standards and ensures that all applicable government entity requirements are within required compliance levels. This is achieved via regulatory-driven compliance audits, use of risk assessment tools, and collaboration with leadership and operational departments. The Corporate Compliance Officer must work both proactively and reactively to all reports of possible compliance issues, establish corrective action plans, as appropriate, and monitor the effectiveness of those plans.

RESPONSIBILITIES & EXPECTATIONS:

• Creating and maintaining an effective corporate compliance program;
• Overseeing the Medicare compliance programs and Payment Integrity department;
• Oversee, coordinate and monitor the day-to-day operation of the Commercial Compliance department;
• Report on a regular basis to AultCare’s Boards of Directors, Audit Committees, Executive Leadership and Commercial Executive Compliance Committee the status of the compliance and FWA programs;
• Keep Chief Compliance officer regularly informed about the status of investigations, audits, concerns or projects;
• Create, maintain and adhere to Compliance Program Integrity department budgets in collaboration with Chief Compliance Officer;
• Periodically revising the commercial compliance program in light of changes in the organization's needs and Federal, State and Local regulations;
• Hire and evaluate compliance colleagues on an annual and as needed basis;
• Ensure employees receive, read and understand the code of business conduct and ethics;
• Developing, coordinating, and participating in a multifaceted educational and training program that focuses on the elements of the compliance program and seeks to ensure that all appropriate employees and management are knowledgeable of, comply with, pertinent Federal and State standards;
• Annually conduct a commercial compliance risk assessment to identify the organization’s compliance risks. This assessment will serve as the basis of the annual compliance auditing and monitoring plans.
• Coordinate internal compliance audit and monitoring activities, including annual or periodic reviews of operational areas;
• Independently investigate and act on matters related to compliance, including the flexibility to design and coordinate internal investigations and any resulting corrective action with all departments, contracted vendors, and if appropriate, independent contractors;
• Maintain centralized tracking of all reported and/or identified compliance issues and corrective action plans;
• Developing policies and programs that encourage managers and employees to report suspected non-compliance, fraud and other improprieties without fear of retaliation;
• Continuing the momentum of the compliance program;
• Track and implement, as needed, laws and regulations that affect the organization; meets NCQA requirements.

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent in this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, or veteran status. AultCare is a Federal Contractor and an Affirmative Action employer.

QUALIFICATIONS:

• Bachelor’s degree preferred; minimum Associate’s Degree. Experience in managed care, insurance, or health care field.
• Medicare Advantage, HIPAA, Commercial Insurance and ERISA compliance experience preferred.
• Must be highly organized.
• Must work well with internal and external contact persons.
• Must be able to communicate effectively using verbal and written skills.
• Must be able to work flexible hours and overtime as needed.
• Must be able to work under stress.
• Must have knowledge of and experience using a personal computer in the Windows operating system.
• Displays professional manner and appearance.