Responsible for the strategic direction and long-term planning of an effective compliance process for a specific service line of the Corporate Compliance Program for Children's Health System of Texas (CHST) as outlined by the U.S. Federal Sentencing Guidelines and Office of Inspector General. Primarily responsible for execution of the seven elements of an effective compliance program including other relevant state and federal laws (e.g., Health and Human Services, Texas Department of Insurance). Develops plans to address concerns to mitigate system-wide risk; serves as a subject matter expert and resource for multidisciplinary divisions across CHST, particularly as related to new ventures, to provide interpretation of standards and guidelines
Job Specific Responsibilities
Develops, oversees and maintains a service line within the Compliance Program that continually analyzes the changing regulatory environment and CHST operational goals and objectives to maximize the effectiveness of compliance activities for the service line and across the System, and which demonstrates all the elements of an effective compliance program as defined by the Federal Sentencing Guidelines.
Develops, implements and manages an annual process for identifying and prioritizing organizational risks related to compliance.
Oversees for the Compliance Officer the investigation of actual and potential fraud, waste and abuse violations by Children's Health employees, vendors and other personnel to determine actions to mitigate violations; documents and reports to Compliance Officer or applicable regulations as required.
Ensures that the Compliance Program is coordinated across the various business functions and covered entities of CHST by developing and working with compliance liaisons throughout the organization.
Serves as the primary point of contact for external customers, including providers, patients and their families, and with governmental and regulatory agencies for issues related to compliance.
Fosters a work environment that respects the importance of the privacy of member, client and employee information.
Develops and conducts fraud, waste and abuse training programs and activities for CH employees, and vendors an effective and timely manner.
Identifies, prepares and maintains appropriate and required data, records, reports and other documentation and artifacts to report up to the Compliance Officer.
Promotes, and ensures that team members maintain, an environment that supports and encourages the adoption of CHST’s stated values.
Develops and retains a competent staff and responsible for the results of the team.
Exhibits guiding behaviors that reflect Children's values and support the mission and the vision.
Works diligently to foster a culture and climate of sensitivity to ethical and compliant behavior within the organization.
Responsible for the budget and financial health of the division.
Required: Demonstrated knowledge and successful implementation of the elements of an effective compliance program, including policy and procedure development, training program development and delivery, risk assessment and auditing/monitoring processes, and appropriate and effective investigation processes.
Required: At least 7 years of extensive experience in the practical application of the U.S. Federal Sentencing Guidelines on compliance regulations with a minimum of 3 years of experience in an academic medical center, multi-organization health system or insurance industry.
Required: Four-year Bachelor's degree or equivalent experience
Required: Graduate or professional work or advanced degree; or equivalent experience
Specific Knowledge, Skills and Abilities
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures. Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions. Translate strategic priorities into operational reality; align communication, accountabilities, resource capabilities, internal processes, and ongoing measurement systems to ensure that strategic priorities yield measurable and sustainable results. Identify and drive organizational and cultural changes needed to adapt strategically to changing market demands, technology, and internal initiatives; catalyze new approaches to improve results by transforming organizational culture, systems, or products/services. Establish and commit to a long-term business direction after considering clinical and financial data, resources, market drivers, and organizational values; anticipate and respond to shifts within the market, technology, or policy environment that influence the delivery, management, and financing of healthcare. Vividly communicate a compelling view of the future state in a way that helps others understand and feel how business outcomes will be different when the vision and values become a reality. Provides feedback, instruction, and development guidance to help others excel in their current or future job responsibilities; plan and support the development of individual skills and abilities. Interact with others in a way that gives them confidence in one's intentions and those of the organization. Demonstrate a poised, credible, and confident demeanor that reassures others and commands respect; convey and image that is consistent with the organization's vision and values. Clearly and succinctly convey information and ideas to individuals and groups; communicate in a focused and compelling way that captures and holds others' attention.
Licenses and Certifications
Required: Certified in Healthcare Compliance (CHC) or equivalent.
Sedentary - Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.
that Children’s Health provide for our patients and employees makes this an enjoyable place to be. As a system, there is a lot of room for professional and personal growth, with opportunities to further your education and your career.
Point of Care Coordinator