Compliance and Risk Officer

Job Description

Job Description

Summary

The Compliance and Risk Officer serves as the organization's designated leader for compliance, risk management, HIPAA privacy, patient safety, regulatory oversight, investigations, and ethics. This position is an enterprise-wide leadership role accountable for maintaining an effective culture of compliance, privacy, safety, and risk reduction throughout the organization.

The Compliance and Risk Officer is responsible for the development, implementation, oversight, and continuous improvement of Providence Community Health Centers' Corporate Compliance Program, Enterprise Risk Management Program, Patient Safety Program, and Health Insurance Portability and Accountability Act (HIPAA) Privacy Program. The Compliance and Risk Officer serves as the organization's designated Compliance Officer and HIPAA Privacy Officer and provides support in identifying, assessing, mitigating, and monitoring organizational risk while ensuring compliance with applicable federal and state laws, regulations, contractual requirements, and organizational policies.

The Compliance and Risk Officer serves as a strategic advisor to executive leadership, leads the Corporate Compliance Committee, and Risk Management Committee, and presents to the Board of Directors regarding compliance, ethics, privacy, patient safety, and enterprise risk management. The position works closely with leadership, providers, staff, legal counsel, corporate insurance agents, regulators, auditors, payors, and other external agencies to promote a culture of compliance, accountability, safety, and continuous improvement.

Essential Duties and Responsibilities

Corporate Compliance

• Serve as the organization's Compliance Officer and oversee the Corporate Compliance Program.
• Develop, implement, and maintain compliance policies, procedures, training, monitoring, and auditing activities to promote adherence to legal, regulatory, and organizational requirements.
• Conduct compliance risk assessments, develop mitigation strategies, and prepare annual compliance work plans.
• Monitor compliance with applicable federal and state healthcare laws and regulations, including HIPAA/HITECH, Stark Law, Anti-Kickback Statute, False Claims Act, Medicare, Medicaid, and FTCA requirements.
• Oversee compliance investigations, audits, hotline activities, corrective action plans, and reporting processes.
• Promote reporting of compliance concerns and ensure timely investigation, resolution, and regulatory reporting when required.
• Chair the Corporate Compliance Committee and provide regular reports to executive leadership and the Board of Directors.
• Collaborate with Human Resources and operational departments to support exclusion screening and other compliance requirements.

HIPAA Privacy Officer

• Serve as the organization's HIPAA Privacy Officer and oversee the Privacy Program.
• Develop and maintain privacy policies, safeguards, training, and compliance monitoring activities to protect PHI and ePHI.
• Conduct privacy risk assessments and compliance reviews.
• Investigate privacy complaints, breaches, and unauthorized disclosures, and coordinate required notifications and reporting.
• Oversee privacy-related Business Associate Agreement requirements and provide guidance regarding patient privacy rights, confidentiality, and release of information practices.
• Partner with Human Resources, Health Information Management, Information Technology, and operational leaders to ensure privacy compliance and appropriate corrective actions.

Risk Management and Patient Safety

• Serve as the organization's Risk Officer and oversee the Enterprise Risk Management and Patient Safety Programs.
• Develop and maintain risk management policies, procedures, training, and monitoring activities designed to identify and mitigate organizational risk.
• Review, investigate, and trend incident reports, patient complaints, adverse events, near misses, and patient safety concerns.
• Conduct investigations, prepare reports, and recommend corrective actions to address operational, clinical, regulatory, and liability risks.
• Identify systemic issues and emerging risks and develop mitigation strategies to reduce organizational exposure.
• Present findings and recommendations to leadership and the Risk Management Committee.
• Coordinate FTCA risk management activities, claims management, insurer reporting, and annual deeming support.
• Ensure timely reporting of incidents to insurers, FTCA representatives, and regulatory agencies as required.
• Partner with credentialing staff and organizational leaders to support safe, high-quality patient care and promote a culture of safety and continuous improvement

Develop and maintain risk management policies, procedures, training, and monitoring activities designed to identify and mitigate organizational risk.

Qualifications

• Minimum of five (5) years of progressively responsible experience in healthcare compliance, risk management, privacy, auditing, quality improvement, or related healthcare operations required.
• Experience in a Federally Qualified Health Center (FQHC), community health center, ambulatory care, or other patient-centered healthcare environment preferred.
• Demonstrated experience conducting investigations, compliance audits, risk assessments, corrective action planning, and policy development.
• Strong knowledge of healthcare regulatory requirements, reimbursement programs, quality standards, privacy laws, and risk management principles.
• Comprehensive knowledge of healthcare compliance, privacy, risk management, patient safety, and ethics programs.
• Strong analytical, investigative, auditing, and problem-solving skills.
• Excellent written, verbal, presentation, and interpersonal communication abilities.
• Ability to maintain confidentiality and exercise sound judgment in highly sensitive matters.
• Ability to interpret and apply complex regulatory requirements.
• Demonstrated leadership, project management, and organizational skills.
• Ability to work effectively across all levels of the organization and manage multiple priorities simultaneously.

Education- Required

• Bachelor's degree in healthcare administration, public health, business administration, nursing, law, compliance, or a related field, or an equivalent combination of education and experience.

Education- Preferred

• Certified in Healthcare Compliance (CHC).
• Certified Professional in Healthcare Risk Management (CPHRM).
• Certified Information Privacy Professional (CIPP) or equivalent privacy certification.
• Other applicable healthcare compliance, privacy, or risk management certifications.

Working Conditions

• Ability to travel between the organization’s locations as needed.
• Reliable transportation, valid driver’s license, and proof of insurance required.

Lauguage Skills

Ability to read, analyze, and interpret technical directives; write reports; effectively present information; and respond to questions from employees and the general public.

Mathematical Skills

Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written or oral form and to deal with problems involving several variables.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle or feel.
2. The employee frequently is required to reach with hands and arms.
3. The employee is required to stand, walk and climb or balance.
4. The employee must occasionally lift and/or move up to 10 pounds.
5. Specific vision abilities required by this job include color vision, close vision and ability to adjust focus.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Summary of Occupational Exposure

Classified by the Centers for Disease Control and Prevention as low risk.