Director of Compliance - Healthcare - Cantex

Job Details

Job Location

Cantex Continuing Care Network LLC - Carrollton, TX

Position Type

Full Time

Description

Job Summary:

The Director of Compliance is responsible to oversee, lead and administer the Cantex Compliance Program across all divisions in alignment with the Company policies and procedures including the Health Plan, Code of Conduct, Quality Hotline, Monitoring, Auditing/trending/tracking and summary reviews. This position will be responsible for adherence to the requirements and guidance set forth by various regulatory authorities, such as OIG, DOJ, CMS, and HHSC.

Benefits:

• Competitive Wages
• 401k with match
• Medical, Dental, Vision & Supplemental Insurance
• Vacation, Sick, Personal Holiday & Paid Holidays
• Short-Term Disability
• Life Insurance
• Tuition & CEU Reimbursement
• Work today & get paid tomorrow with PayActiv
• Rewards & Recognition Program
  
  

Qualifications

Qualifications:

• Experience with compliance and ethics-related education and training, organizational culture and communications, key performance indicators, documentation retention, policies and procedures, and risk assessment
• Certification in Healthcare Compliance and Bachelor’s degree preferred
• Minimum three (3) years' experience in healthcare operations or compliance, preferably with a multi-faceted healthcare company
• Minimum of three (3) years supervisory experience, preferably in a long-term care setting.
• Experience leading a Compliance Program for an I-SNP required.
• Thorough knowledge of applicable state/federal regulations regarding nursing home operations and should include a detailed understanding of state and federal programs
• Ability to effectively communicate, direct, and at times, delegate tasks.
  
  

Essential Functions:

• Creating and update compliance programs, policies, and procedures designed to ensure compliance with all applicable federal laws and regulations.
• Partner with company leadership to ensure that the compliance program effectively prevents, detects and responds to violations of law, regulations, policies and industry standards.
• Provide exemplary leadership in promoting the Company’s commitment to compliance and those ethical and compliance values that are reflected in the Compliance Program.
• Review the content and performance of the Compliance Program on a continuing basis and take appropriate steps to improve its effectiveness.
• Receive, intake, monitor, and track Quality Hotline and Compliance calls and work with department leaders in ensuring resolution.
• Establish mechanisms and promote an environment where employees and business partners can report compliance related issues via any communication channel available within the Company without fear of retaliation, which includes, but is not limited to, the maintenance of an independent call-in number where employees may anonymously report compliance-related concerns.
• Promotes sound clinical management principles and strategies in order to identify risks in the clinical setting and coordinate the development of actions to reduce opportunities for harm to patients, visitors and staff.
• Responsible for development and implementation of network-wide education for compliance with external accrediting agencies standards and state and federal regulations.
• Participate and present in various compliance committees to ensure compliance protocols are in place.
• Review and oversee, either personally or through coordinated efforts with senior management, the prompt resolution of any alleged violations of the law, rules or regulations, the Code of Conduct or other established Company policies and procedures.
• Supervise and maintain the integrity of the Ethics hotline such that reports are appropriately logged, investigated, tracked and resolved in a timely manner; calls can be made on an anonymous basis where permitted by law; and the confidentiality of the information is maintained to the maximum extent possible.
• Monitor CMS and Federal regulatory updates and update respective department of necessary changes that need to be adopted.
• Develop and maintain documents related to the operation of the Compliance Program including, but not limited to, the Compliance Plan, the Code of Conduct, policies and procedures and educational materials. Coordinate revisions to the Compliance Plan or Code of Conduct, as necessary, in order to respond to the changing needs of the Company and changes in the laws, rules and regulations governing the Company.
• Perform periodic audits in the facilities that are deemed “critical” as it relates to the error rate and exposure. The audits will be to determine whether the documentation in the medical record supports the intensity and the medical necessity of the services billed. The results shall be shared with key leadership in the respective facility.
• Monitor key factors as they relate to the documentation of medical necessity in the Communities. These factors include (1) RUG classifications, (2) problematic diagnoses, (3) error rate, (4) patterns of denials, and (5) adherence to applicable CMS and Local Coverage Determination regulations.
  
  

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