Compliance Officer

Compliance Officer

Tuolumne Me Wuk Indian Health Center Inc. | Sonora, CA, 95370, US
Salary Range:$56,000 – $85,000 Salary range estimated by Zippia

Posted 6 days ago

Apply Now


Develops, directs and maintains the TMWIHC Compliance Program. Chairs and maintains documentation of the QAPI team and reports monthly with Health Board Compliance Committee and coordinates with Legal Counsel as needed. Develops, administers and monitors implementation of the TMWIHC wide plan to comply with state, federal and accreditation requirements, including but not limited to Medi-Cal, Medicare, HIPAA, OSHA, and IHS. Works with TMWIHC managers in preparation, development and implementation of written policies and procedures to achieve compliance with state, federal and accreditation standards. Ensures compliance with revenue generation and reimbursement rules and regulations from CMS and other federal or state funded health care programs. Determines the degree to which TMWIHC meets/exceeds compliance standards through audits and other surveillance tools. Ensures that the medical staff appointees and independent contractors are in compliance with applicable standards, especially with regard to credentialing, coding, and billing practices. Coordinates the processing of internal and external compliance complaints with the QAPI team and Health Board Compliance Committee. Recommends and implements resolution strategies for identified compliance issues. Performs compliance assessments in clinical settings and inspects patient care areas. Collaborates with quality and safety personnel to investigate potential or actual occurrences/incidents and necessary reporting. Ensures Compliance Program effectively prevents and/or detects violations of law, regulations, policies, and applicable codes of conduct. Implement and maintain education programs, internal controls, retaliation-free reporting channels, and tracking system for orientation, trainings, investigations and resolutions. Oversees compliance related corrective action plans to ensure follow through to resolution. Performs other duties as assigned. Bachelors degree required. Masters Degree in related field or Juris Doctor preferred or a minimum of five years of experience in a management capacity in a health care setting that required extensive compliance experience. Certified in Healthcare Compliance (CHC) a significant plus (otherwise, required to completed certification within 12 months of employment). Ability to comply with all applicable laws, including tribal ordinances, regulations, policies, and rules. Demonstrated skills in management of complex healthcare issues and evolving tribal organizations are preferred. Ability to work independently and to develop cooperative and effective working relationships with professional health care providers including members of the local medical community. Ability to maintain professional and ethical standards in carrying out responsibilities of position. Must have the ability to maintain confidentiality and handle sensitive matters with discretion and tact. Knowledge of organizational and management practices as applied to the analysis and evaluation of programs, policies, and operational needs. Must have a valid, current California Drivers License; a personal automobile; and personal auto insurance with $100,000/$300,000 bodily injury and $100,000 property damage, or a combined $300,000 single limit. Must have a clean driving record. Must be insurable and eligible for coverage under TMWIHC policies.