HealthLink Compliance Director, HealthLink Health Home

CAMBA•New York, NY

12d•Onsite

About The Position

CAMBA’s HealthLink program is a care management program serving individuals with HIV/AIDS, serious mental illness, or two or more chronic health conditions through coordinated networks of providers. Funded by Medicaid and contracted with two New York State Health Homes, HealthLink staff provide clients with personal care coordinators. The HealthLink Compliance Director oversees and maintains the program’s compliance activities, including its compliance plan, policies, audits, investigations, reporting, and staff awareness. The role works with CAMBA’s board-level Compliance Committee, the HealthLink Compliance Committee, and Senior Program Directors to address findings and improve program compliance and performance. The position reports to the Chief Legal Officer and is based at 2244 Church Avenue, Brooklyn, New York.

Requirements

Bachelor’s degree in healthcare administration, business administration, or a related field.
Five years of experience in roles related to healthcare compliance matters.
Knowledge of federal and New York State healthcare compliance laws and regulations, including HIPAA, NY SOS § 363-d, and 18 NYCRR 521, applicable to Medicaid-funded programs.
Excellent written and verbal communication and interpersonal skills.
Proficiency in Outlook, Word, and Excel.
Strong computer literacy in other Microsoft Office Suite products.

Nice To Haves

Master’s degree.

Responsibilities

Oversee and monitor adoption, implementation, and maintenance of the HealthLink Compliance Program, and evaluate its effectiveness annually in a written report.
Draft, implement, and update the HealthLink Compliance Plan at least annually or as needed to conform to changes in laws, rules, regulations, policies, and standards.
Review and revise the written policies, procedures, and standards of conduct that comprise the HealthLink Compliance Program.
Report regularly, at least quarterly, to CAMBA’s board-level Compliance Committee, including the CEO/President and the Board Member Compliance Committee Chair.
Help establish methods to improve program efficiency and quality of services and reduce vulnerability to fraud, waste, and abuse.
Investigate and take action on matters related to the HealthLink Compliance Program independently of program interests in protecting billing outcomes; design and coordinate internal investigations and document, report, coordinate, and pursue resulting corrective action.
Assess and document in writing the support provided by existing HealthLink staff in implementing compliance functions, and share the assessment with the HealthLink Compliance Committee.
Conduct standard random and focused audits of HealthLink activities for compliance with applicable funding and regulatory sources, including lead Health Homes, Medicaid, DOHMH, and DOH.
Record, aggregate, analyze, and report audit results; identify trends and root causes; and recommend program or performance improvements.
Promote HealthLink staff awareness of compliance matters and encourage reporting of compliance issues.
Monitor compliance with policies and procedures applicable to the HealthLink program.
Meet and work with Senior Program Directors to discuss findings and implement changes.
Assist with chart reviews required by lead Health Homes and internal chart reviews assigned by Senior Program Directors, and report findings to Senior Program Directors.
Participate in team meetings and lead compliance discussions at monthly site meetings.
Maintain client confidentiality.
Attend trainings for continued professional development.
Perform other duties as assigned.