Director of Quality & Compliance

Job Description

Job Description

Director of Quality and Compliance

Department : Administration

FLSA Status : Exempt

Reports To : Board of Directors

Hours of Work : 40+

Working Title : Director of Quality and Compliance

Classification : Full-time

Pay Grade : G-15 ($105,407.79 - $126,489.34)

FTE : 1.0

Location : 1453 W. Temple St; other locations

Approved / Revised Date : 07 / 08 / 2024

Job Summary

The Director of Quality and Compliance is a highly detail-oriented healthcare professional who combines healthcare industry knowledge, technology experience, and compliance expertise to ensure the organization follows all laws governing healthcare information.

The primary focus will be to identify and mitigate compliance risks, conduct audits and reviews, and provide guidance to staff with a certain level of quality assurance.

Additionally, this position will function as UAII's privacy officer, overseeing the development, implementation, maintenance of, and adherence to privacy policies and procedures regarding the safe use and handling of protected health information (PHI) in compliance with Federal and State Health Insurance Portability and Accountability Act (HIPAA) regulations.

Job Duties & Responsibilities

Risk Management

• Review incidents, claims, and liability reports to identify risks in the organization.
• Prevent patient privacy breaches.
• Educate and provide solutions to employees about risk, liability, and risk management policies and procedures.
• Create a risk management plan to help avert future problems, including internal risk assessments.
• Reviews hospital and medical malpractice and liability insurance.
• Monitor other staff in the organization to ensure compliance.

Quality Assurance

• Develop and implement comprehensive quality assurance policies and procedures.
• Monitor and assess compliance with healthcare regulations and standards.
• Maintains a safe and healthy work environment by following standards and procedures and complying with legal regulations.
• Prepare and present analytics to the leadership team.
• Audit department records and processes related to the general department functions, including but not limited to billing, training, credentialing and privileging, patient upkeeping, and regulatory documents.

Compliance

• Oversees healthcare compliance programs promoting ethics and integrity in clinical processes and procedures.
• Develop a plan of action for any relevant compliance metrics.
• Responsible for managing adherence to federal and state laws, regulatory guidelines, and Medicare and Medicaid Service requirements, including OIG requirements.
• Review and relay all regulatory documents.
• Develop policies and procedures that comply with federal and state regulations.
• Provide departmental guidance to healthcare units regarding their specific compliance requirements.
• Perform other related duties as assigned.

Minimum Qualifications (Education & Experience)

• Bachelor's Degree in Healthcare Administration, Law, Business Administration, or other related field.
• Five (5) years of experience in compliance or in other related fields.
• Experience working with nonprofit organizations, community groups, and performance-based government contracts.
• CHC (Certification in Healthcare Compliance), CHCP (Certification in Healthcare Privacy Compliance), CHRC (Certification in Healthcare Research)
• A combination of experience, education, and training may substitute for degree requirements on a year-for-year basis.

Preferred Qualifications (Education & Experience)

• Master's Degree in Healthcare Administration, Law, Business Administration, or other related field.
• Seven (7) years of experience in compliance or in other related field.
• Experience working with the American Indian / Alaskan Native community.
• Experience working with nonprofit organizations, community groups, and performance-based government contracts.

Necessary Knowledge, Skills, and Abilities

• Knowledge of OIG standards.
• Knowledge of working with key agencies, including healthcare compliance, public health agencies, and public safety agencies.
• Knowledge of occupational safety and health protocols, procedures, and standards.
• Knowledge of the Indian Self-Determination and Education Assistance Act (PL93-638).
• Knowledge of Title V of the Indian Health Care Improvement Act (PL 94-437).
• Knowledge of the Affordable Care Act (PL 111-148).
• Strong understanding and sensitivity to American Indian / Alaska Native (AI / AN) cultures and lifestyles, and work effectively with AI / AN population.
• Effective oral and written communication skills with sensitivity to the lifestyles of targeted participants.
• Skills in operating personal computers using various computer software (Microsoft Office, Adobe, Microsoft Teams, Zoom).
• Ability to maintain strict confidentiality of client and personnel information and comply with all applicable federal and state privacy laws, as well as UAII policy (HIPAA, HITECH, etc.

Including the State of California regulations and the Privacy Act.

• Ability and willingness to travel to other worksites; additional travel may include conferences and workshops.
• Ability to work evenings and weekends as needed.
• Excellent analytical and problem-solving skills with the ability to identify and mitigate compliance risks.
• Detail-oriented with exceptional organizational and documentation skills.
• Effective communication and interpersonal skills to collaborate with staff members at all levels.
• Ability to work independently and manage multiple priorities in a fast-paced environment.
• Ethical and professional conduct with a commitment to maintaining confidentiality.
• Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.
• Comfortable speaking in public and interacting one-on-one with employees at all levels in the organizations and vendors.
• Ability to keep up with a fast-paced environment.
• Ability to learn and apply program / agency operating policies and procedures.
• Ability to manage multiple priorities and tasks concurrently and meet deadlines.
• Ability to interact with various people on various, and at times, complex issues.
• Ability to work independently as well as with teams.
• Ability to learn new skills and participate in training sessions relevant to the position.

Working Conditions

The work environment characteristics described here represent those employee encounters while performing the primary functions of this Job.

Normal office conditions exist, and the noise level in the work environment can vary from low to moderate.

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.

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear.

The employee is frequently required to stand and / or sit. The employee is occasionally required to walk, sit and climb or balance.

The employee must frequently lift and / or move up to 10 pounds and occasionally lift and / or move up to 25 pounds. Specific vision abilities required by this Job include close vision, peripheral vision and depth perception.

Conditions of Hire

• Eligibility to work in the US.
• Fingerprint clearance.
• Pass a post-offer drug test.
• Negative TB test result (annual requirement).
• Proof of vaccination against the flu (annual requirement).
• Proof of full vaccination against COVID, including one booster.
• Valid CA driver's license if driving for the company and / or a requirement of the position.
• Maintain auto insurance coverage if driving for the company.

United American Indian Involvement, Inc. (UAII) provides equal employment opportunities (EEO) to all employees and applicants for employment.

UAII is a drug-free workplace and complies with ADA regulations. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.