Compliance and Quality Improvement Specialist

Coordinated Care Services, Inc. (CCSI) • Norwich, NY

114d

About The Position

At CCSI, our mission is to activate possibilities for our customers and employees through collaboration, compassion, equity, and imagination. For more than 30 years, CCSI has been a leading non-profit partner to local governments, schools, and community-based organizations, helping them improve their business processes so they can focus on their missions. If you’re looking for a career with purpose that creates lasting change in the community, we encourage you to apply. We are seeking a talented Compliance and Quality Improvement Specialist to join our team of nearly 500 employees. CCSI’s Consulting and Technical Assistance Services provides customers with specialized consultation and staffing in areas like Finance, Revenue Cycle Management, Human Resources, and Business Intelligence, tailored and scaled to meet the needs of small to mid-sized not-for-profit organizations. As systems and funding structures continue to evolve at a rapid pace, so must an organization’s business infrastructure. CCSI partners with organizations across New York state, providing the business services needed to support the not-for-profit community in delivering innovative, high-quality services.

Requirements

• Bachelor’s degree in relevant field (Master’s degree preferred) and 5 years’ experience in a health care organization, or equivalent education and work experience.
• Healthcare Compliance certification or Graduate Certificate in Healthcare Compliance preferred.
• Satisfactory completion of all required background screenings.
• Valid Class D New York State Driver License and satisfactory driving record to meet travel requirements of position.
• Respect the confidential nature of all CCSI and CCSI customer information you are exposed to in the course of your work performance.

Nice To Haves

• Communicating effectively; excellent written and verbal communication skills.
• Building collaborative relationships.
• Valuing diversity and fostering an inclusive environment.
• Striving for self-development and taking initiative to be resourceful.
• Problem-solving both independently and with others.
• Working knowledge of applicable federal and NYS healthcare laws, regulations and statutes, including Medicaid, Office of Mental Health (OMH) and Office of Addiction Services and Supports (OASAS) regulations.
• Strong knowledge of mandatory healthcare compliance program requirements as detailed by NYS Office of Medicaid Inspector General.
• Working knowledge of legislative review and interpretation.
• Proficient in database technology, specifically electronic health record systems.
• Project management and analytical skills.
• Ability to function independently and proactively in rapidly changing environments.

Responsibilities

• Oversee and monitor implementation of the Compliance Program under guidance of CCSI Chief Compliance and Privacy Officer.
• Develop, execute, maintain and revise policies and procedures for general operation of compliance and quality programs and corporate level policies for the organization.
• Review effectiveness of compliance and quality programs annually and updates plan, policies and procedures as warranted to reflect changes in law, regulations, payer requirements or CCCMHS operations.
• Stay active and up to date on all material and releases regarding regulatory compliance.
• Establish Annual Compliance and Quality Work Plan and Audit Schedule for review/approval by the Compliance Committee, Director of Community Services, and Community Services Board (CSB).
• Regularly review and update the local Code of Conduct, as warranted.
• Ensure establishment and implementation of monthly exclusion check review of all employees, vendors, board members and agents of CCCMHS to ensure that individuals excluded from participating in federal health care programs are not employed or retained by the CCCMHS.
• Coordinate compliance and quality-related training and education sessions for CCCMHS workforce and CSB.
• Establish and operationalize internal evaluation and auditing processes, including billing audits and quality documentation audits that are routine and effectively identify and mitigate compliance and quality issues.
• Maintain compliance-specific reporting system (hotline) that allows for anonymous reporting of compliance issues, concerns or questions.
• Respond and independently investigate all reports of compliance and quality issues/incidents immediately and with due diligence.
• Consult with legal counsel as warranted and appropriate.
• Maintain a log of known or suspected non-compliance with applicable standards.
• Track and trend investigative results and outcomes and report any sustained issues that imply or confirm non-compliance within the organization to the Compliance Committee, Director of Community Services, and Community Services Board (CSB).
• Report on a regular basis to CSB, Director and Compliance Committee on effectiveness of CCCMHS Compliance and Quality programs.
• Act as an available resource and guide for all staff in matters of compliance and quality.
• Act as liaison with external auditors during external oversight audits/reviews/certifications, etc.
• Serve as Chairperson of Compliance Committee.
• Serve as Chairperson of CQI Committee.
• Monitor regulations specific to HIPAA, 42 CFR Part 2 and all applicable privacy and security laws.
• Ensure submission, after full review, of agency’s Annual Compliance Program Certification under the Social Service Law and as applicable, the Deficit Reduction Act.
• Perform other duties as assigned.

Benefits

• Market-competitive compensation
• An award-winning Wellness@Work and employee benefits program.
• Continuous professional development opportunities.
• A voice in shaping CCSI’s ever-evolving diverse company culture.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees