Compliance Specialist

Position Summary:

Under general supervision of the Chief of Quality / Compliance Officer, the Compliance Specialist provides direction and oversight of the compliance program. The Compliance Specialist at Sage Memorial Hospital (SMH) is tasked with monitoring the compliance programs. This role ensures that all operations and practices comply with regulatory requirements, ethical standards, and organizational policies, maintaining integrity and minimizing risk. Key responsibilities include ensuring department compliance with the Joint Commission, ADHS, HIPAA, and accreditation standards, monitoring compliance with federal, state, and local regulations, keeping up to date with laws and regulations, and preparing compliance reports for senior management.

This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive.

Essential Duties & Responsibilities:

• Develop, implement, and maintain thorough compliance programs and policies in line with federal, state, tribal, and organizational regulations and standards.

• Conduct regular compliance audits, assessments, and reviews to pinpoint areas of noncompliance, assess risks, and execute corrective actions.

• Provide staff guidance, training, and education on compliance-related matters, such as privacy, security, fraud, waste, and abuse prevention.

• Act as the primary point of contact for compliance-related inquiries, investigations, and reporting to regulatory agencies, tribal leadership, and other stakeholders.

• Stay informed about changes in laws, regulations, and industry standards pertinent to healthcare compliance and communicate updates to relevant personnel.

• Address compliance concerns, complaints, or allegations through appropriate investigation, documentation, and resolution processes.

• Develop and maintain effective communication channels and report mechanisms for reporting compliance issues, concerns, and violations.

• Prepare and submit necessary compliance reports, certifications, disclosures, and attestations to regulatory agencies and oversight bodies.

• Participate in compliance committees, task forces, and working groups to tackle emerging compliance issues, develop best practices, and promote a culture of compliance within the organization.

• Provides reports on a monthly, quarterly, and annual basis to the Quality Council, Executive Committee, and Board of Directors.

• Oversees the development, initiation, maintenance, and revision of policies and procedures for the operation of the Compliance program and their related activities to prevent and detect illegal, unethical or improper conduct.

• Detects potential for fraud, waste, and abuse, and identifies aberrant patterns and trends through data analytics.

• Develops methodologies for and oversees the implementation of auditing and monitoring activities in accordance with the annual compliance work plan.

• Implements and maintains effective line of compliance communication throughout the organization including the implementation and use of a companywide compliance hotline and facilitating heightened awareness of the Code of Conduct and related policies and procedures.

• Monitors the performance of the program on a continuing basis, taking appropriate steps to improve its effectiveness.

• Provides support to the Compliance Officer.

• Other duties as assigned

Knowledge, Abilities, Skills, and Certifications:

• Good Management and Leadership skills.

• Well-developed interpersonal skills

• Willing and able to foster the team and continuous quality improvement concepts

• Knowledge of healthcare laws and regulations related to HIPAA compliance, privacy rules, Stark Law, Anti-kickback statue, and billing best practices

• Working knowledge of the Joint Commission requirements and standards

• Working knowledge of the False Claim Act – Federal and State

• Analytical abilities and critical thinking

• Ability to work independently and make decisions under pressure

• Conflict resolution

• Change and project management

• Attention to detail

• Problem-solving

• High Ethical standards

• Strong facilitator

• Credible and authoritative

• Verbal and written communication skills

• Ability to speak the Navajo language and/or familiarity with the Navajo Way.

Physical Demands:

While performing the duties of this job, the employee regularly is required to sit; reach with hands and arms; and talk or hear. The employee frequently is required to walk. The employee occasionally is required to stand; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment:

Work is generally performed in an office with moderate noise level. Extended hours and irregular shifts may be required.