Compliance Officer

Salary : $171,610.40 - $209,258.40 Annually

Location : Throughout the County of Santa Clara, CA

Job Type : Full-Time

Job Number : 25-C41-A

Department : Santa Clara Valley Health Care - Valley Medical Center

Division : Health & Hospital System Compliance

Opening Date : 01 / 28 / 2025

Closing Date : 2 / 28 / 2025 11 : 59 PM Pacific

Bargaining Unit : 92

Description

Under general direction, to coordinate planning, development, implementation, and monitoring of an effective compliance and patient privacy program for the Santa Clara Valley Healthcare.

Managed Care Plan :

One position would be for the Valley Health Plan (VHP) Compliance Officer role. This candidate will be in charge of overseeing VHP's compliance with the various managed care regulations, regulatory filings, delegation and pre-delegation audits, fraud, waste and abuse audits, etc. This position reports to the Chief Compliance Officer - Health System.

Hospital and Clinics :

One position would be for the Santa Clara Valley Healthcare Hospitals and Clinics (SCVH) Compliance Officer role. This candidate will be in charge of overseeing SCVH's compliance with Medicare, Medi-Cal and other federal and state laws and regulations as pertains to hospitals and clinics, as well as conducting risk assessments and audits. This position reports to the Chief Compliance Officer - Health System.

The Power of WE : Together, we can make a greater impact. Bringing better care and expanding healthcare services across the community.

Santa Clara Valley Healthcare (SCVH) is the second largest public health care system in California and includes three acute care hospitals, 14 clinics and 60 specialty and sub-specialty services. Our mission is to provide high-quality, accessible healthcare and excellent service to everyone in Santa Clara County.

Santa Clara Valley Medical Center - SCVMC is a full-service tertiary acute care teaching hospital with 699 licensed beds providing a wide range of specialized services, including Rehabilitation, Burn, Trauma, and NICU. SCVMC was ranked by U.S. News and World Report as #6 Rehabilitation Hospital in the nation and #1 in the West and designated as a 2024 High Performing hospital for Maternity Care, Heart Failure, Stroke, Hip Fracture, and Pneumonia.

O'Connor Hospital - O'Connor Hospital (OCH) is a 358 licensed bed acute care facility offering a full range of inpatient and outpatient medical, surgical and specialty programs to residents of Santa Clara County. It was founded in 1889 as one of the first hospitals in the county. OCH has grown significantly over the past five years in both its inpatient volume and its Emergency Department visits. Along with these volume increases other ancillary and clinical departments like imaging, lab, pharmacy, and respiratory have seen growth as well.

St. Louise Regional Hospital - Since 1989, St. Louise Regional Hospital (SLRH) has been caring for the residents in Santa Clara and San Benito Counties, offering a wide range of inpatient and outpatient medical specialties. SLRH has 93 beds, is a Designated Primary Stroke Center, and is the only acute care hospital in the area. Located in Gilroy, SLRH maintains a CALSTAR 2 emergency helicopter base on the premises.

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Typical Tasks

The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.

• Implements system-wide programs, policies, and procedures to ensure compliance with applicable federal and state laws and regulations, such those related to Medicare, Medi-Cal, managed care, commercial insurance, federal and state contracts and grants, and other applicable programs and funding sources;
• Implements a system-wide patient privacy program by working closely with department leaders to ensure compliance with federal, state, and contract privacy laws and regulations, such as the Health Insurance Portability and Accountability Act, California Confidentiality of Medical Information Act, Lanterman Petris Short Act, 42 C.F.R. Part 2, etc.;
• Directs activities for system-wide audits to investigate and monitor healthcare privacy, healthcare billing, and contract compliance with standards and procedures required by federal and state laws, including supervising the audit activities conducted by contracted consultants;
• Develops, writes, and implements a code of conduct, policies, and procedures that establish standards for an organizational culture of compliance, privacy, and ethics, giving specific guidance to management, medical staff, and individual departments or employees, as appropriate;
• Develops, implements, and provides orientation and ongoing educational programs via various communication platforms designed to specifically promote an understanding of compliance and privacy issues, laws, and regulations and the consequences of non-compliance throughout the County of Santa Clara Health System (CSCHS);
• Maintains an awareness of compliance and privacy laws and regulations, keeping abreast of current changes that may affect healthcare systems through personal research, seminars, and peer contact;
• Reviews and leads inquiries concerning billing and reports of noncompliance; reviews results of documentation compliance audits;
• Participates in appropriate response, develops corrective action plans, and oversees compliance and privacy investigations, including maintaining the confidentiality of information reported by individuals in order to protect both the individual and the subject of the investigation;
• Provides analysis of data sharing projects, including mapping data flows, analyzing data elements, interpreting federal and state privacy laws, and collaborating with the Information Security Office to ensure secure and appropriate release and storage of the Health System's patient health information;
• Implements and maintains a system for encouraging staff to report non-compliance and potential fraud, waste, and abuse without fear of retaliation;
• Reviews complaints, concerns, or questions relative to compliance issues and provides consultative leadership and support to all entities as appropriate;
• Ensures that internal controls throughout the system are sufficient to provide for accurate, complete, and compliant programs and processes;
• Serves as a subject matter expert on relevant technology projects, providing expertise and guidance on the identification and mitigation of compliance and privacy risks, including potential False Claims Act violations, inaccurate documentation and billing, and breaches of federal and state privacy law;
• Serves as the main point of contact for state and federal agencies conducting external audits and compliance and privacy investigations and leads the organization to ensure appropriate and timely responses;
• Develops corrective action plans and oversees investigations, including maintaining the confidentiality of the investigation;
• Organizes and leads Compliance Committees for the Health System Departments, including Hospitals and Clinics, Behavioral Health Services, Valley Health Plan, Custody Health, Public Health, and Emergency Medical Services, as well as represents Compliance on other County and Health System committees;
• Prepares regular and timely reports to the Chief Compliance Officer, County Health System Leadership, and Compliance Committees on compliance and privacy issues and activities, including major findings, problems, and violations, and recommends remedial correction and prevention actions;
• Promotes awareness and understanding of positive ethical and moral principles consistent with the mission, vision, and values of the organization and those required by federal and state law;
• Interacts with all levels of management throughout the County of Santa Clara Health System;
• Establishes guidelines and procedures for ongoing compliance review to identify risks and deficiencies, develop annual work plans, and recommend corrective action plans;
• Supervises subordinate staff, including Program Managers and Compliance analysts;
• May be assigned as a Disaster Service Worker (DSW), as required;
• Performs other related duties, as required.

Employment Standards

Sufficient education, training, and experience to demonstrate the ability to perform the above tasks, plus the possession and direct application of the following knowledge and abilities :

Training and Experience Note : The required knowledge and abilities are attained through possession of a Bachelor's degree, preferably in healthcare administration, finance, accounting, auditing, and / or a related field

Five (5) years of professional level compliance and / or financial management experience, at least two (2) years of which must be in a healthcare setting. Healthcare setting includes Health Plan, Clinic, and / or Hospital.

Special Requirements

Knowledge of :

Ability to :

Physical Requirements :

The County offers comprehensive first-class medical, dental, and vision benefits plans for County employees and their dependents, including plans with no deductibles, no co-pays, no co-insurance, and no prescription drug co-pays. Learn more

The County also offers generous paid time off with significant vacation, sick time, and 13 paid County holidays annually! Details are included in the with the bargaining unit applicable to the job classification.

In addition to the amazing perks above, the County also offers the additional benefits below.

Retirement Benefits

The County offers robust retirement plans including a (similar to the private sector's 401(k) plan) and the In addition to lifetime retirement income available through the CalPERS pension plan, the 457(b) Deferred Compensation plan provides a great way to save for retirement and supplement the defined benefit pension available to employees. These plans help our employees build a plan for their future and contribute to their family's long-term financial well-being.

Health Flexible Spending Account

The empowers employees to manage healthcare expenses efficiently with tax-free contributions (up to $3,200 for the 2024 calendar year). Secure tax-free solutions for your healthcare expenses and enjoy the flexibility to manage your healthcare finances effectively with the HFSA.

Dependent Care Assistance Program (DCAP)

The enables employees to utilize tax-free funds for dependent care services, facilitating a convenient and cost-effective approach for managing your dependent care expenses. The County also offers the , an employer-funded DCAP, for employees with annual income under $120,000.

Life and AD&D

The County offers life and disability benefits including , Insurance, These benefits ensure financial security and income support when you and your family need it most.

Employee Assistance Program (EAP)

The County prioritizes employee mental health and well-being and offers a top-tier through Concern providing confidential counseling sessions covering stress, anxiety, relationships, grief, as well as financial / legal services, personal coaching, child and elder care referrals, and comprehensive crisis support.

Employee Wellness

The offers free wellness programing, fitness classes and resources; including Elevate My Wellness an all-in-one platform designed to elevate your well-being journey.

Education Reimbursement

A generous program is available, including Education Reimbursement for employees seeking additional training and professional development.

NOTE : Benefit and Retirement information may vary from bargaining unit to bargaining unit. Due to changes in State Law, current pension provisions described in the union contracts are not automatically applied. Specific pension benefits for new hires who start on or after January 1, 2013 may be different than indicated in the union contracts.

Click here to access all Memoranda of Understanding and most recent Summary of Changes.

Please answer the following questions. Completion of the following supplemental questions is REQUIRED for your application and is an integral part of the evaluation process. Initially, it will be used to evaluate against the employment standards. For those applicants meeting the employment standards, this information will be critical in the subsequent competitive assessment to identify those candidates to be invited to continue in the examination process. Your responses to the questions may also be reviewed and scored in a Competitive Rating evaluation process based on pre-determined rating criteria. Your answers should be as complete as possible, as no additional information will be accepted from applicants once the Competitive Rating evaluation has begun. Please include the name of employer, job title, dates of employment and number of hours worked per week for questions asking about your experience. A response of "see resume" or "see application" will deem your application incomplete. Vague, incomplete or non-responsive answers could result in no or low scores in a competitive rating process. Do you understand this requirement?

What is the highest level of education you have completed?

Do you have a BA or higher in any of the following?

Please list the name of all degrees, the level, and where it was obtained. If you do not have any write "none."

How many years of professional level compliance management experience do you have?

Describe your professional level compliance management experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

How many years of professional level financial management experience do you have?

Describe your professional level financial management experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

How many years of professional level compliance and / or financial management experience do you have in a hospital and / or managed care plan setting?

Describe your professional level compliance and / or financial management experience in a hospital setting and / or managed care plan.Please include the name of the employer, name of hospital, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

Do you have the following knowledge or experience? (Select all that apply)

For each of the options selected in the previous question, please provide examples of knowledge application and / or experience.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

How many years of professional work experience do you have planning and problem solving compliance and privacy issues?

Provide an example of a time you used planning and problem solving to address a compliance and privacy issue.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

Do you have professional supervisory experience?

Describe your professional supervisory experience. Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".For each relevant position held, please provide specific information that clearly describes : (a) Your functional areas of responsibility.(b) The size and type of each organization.(c) Your position within each organization and the title of the position to which you report(ed).(d) The number and level of staff supervised.(e) How you effectively motivated and managed your team.

How many years of experience do you have administering, implementing, and monitoring a compliance program?

Describe your experience administering, implementing, and monitoring a compliance program.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

Do you have experience working with the following staff? (Select all that apply)

Describe your experience communicating with various levels of staff to explain compliance and privacy matters.Please include the name of the employer, job titles, job duties, dates of employment, and the number of hours worked per week. If none, enter "N / A".

Which compliance area would you prefer to work in? (Select all that apply)

How did you find out about this job?

If you selected an event / fair or other in the question above, please specify. If not, type N / A.

Required Question

Salary : $171,610 - $209,258