Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that's served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It's our passion.

Primary Purpose

Serves as the Compliance & Ethics Officer for Parkland Community Health Plan (PCHP) and reports to the Chief Executive Officer of PCHP. Responsible for leading and maintaining a Compliance & Ethics Program that meets the expectations of federal and state regulations and enforcement officials. Serves as the focal point for all compliance activities at PCHP.

Minimum Specifications

Education

• Bachelor's degree in business administration, healthcare administration, legal studies, or related discipline required.
• Master's degree in business administration, healthcare administration, or a juris doctor preferred.

Experience

Required

• Seven (7) years of leadership experience working in a government, legal, health care, or managed care organization in a compliance, regulatory, or privacy role required.
• Experience managing a compliance program in Medicaid Managed Care, Medicaid, Medicare, or a health plan required.
• Experience with developing and implementing compliance policies and procedures required.

Preferred

• Auditing experience preferred.

Equivalent Education and/or Experience

• Eight (8) years of compliance or regulatory leadership experience in Texas Medicaid or Medicaid Managed Care may be considered in lieu of a bachelor's degree.

Certification/Registration/Licensure

• Ethics and Compliance Initiative certified Leadership Professional in Compliance & Ethics (LPEC), HCCA Certified in Healthcare Compliance (CHC), or AAPC Certified Professional Compliance Officer (CPCO) required within two (2) years from date of entry into the position.

Skills or Special Abilities

• Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines and with a variety of constituents as well as the ability to articulate complex information in understandable terms.
• Demonstrated ability to coach and influence for results.
• Excellent people skills with the ability to establish and maintain effective working relationships with diverse groups across and beyond the organization including boards and governing bodies.
• Demonstrated ability to lead major organizational initiatives, accomplish results, and achieve measurable outcomes or goals.
• In-depth knowledge of federal and state regulatory expectations with respect to effective managed care compliance programs.
• Knowledge of investigative techniques along with the ability to organize, analyze, and effectively determine risk with corresponding solutions.
• Strong time management skills with the ability to manage multiple demands and respond to rapidly changing priorities.
• Knowledge of Texas Medicaid (STAR, STAR Kids/CHIP) program, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual.
• Proficient Microsoft Office and computer skills.

Responsibilities

Compliance and Ethics Program

• Provides overall guidance and oversight for the development, implementation, ongoing administration, and monitoring of practices which promote an effective Compliance Program.
• Oversee, administer, and implement various compliance programs including HIPAA.
• Accountable for the development and implementation of strategies and processes to ensure compliance with laws, regulations, and policies that govern managed care organizations including the Centers for Medicare and Medicaid Services (CMS), the Texas Department of Insurance (TDI), the Office of Civil Rights (OCR), and the Health and Human Services Commission (HHSC).
• Ensure the seven elements of an effective compliance program are implemented and performed.
• Develops policies and procedures for compliance programs to ensure employee awareness of the compliance programs, develop compliance related reporting, prepare compliance risk assessment analysis for departments, and promote the awareness and understating of these programs with high ethical and moral principles consistent with Parkland's Mission, Vision and Values.
• Organizes and leads the Health Plan Compliance Committee, including the development of appropriate agendas, reports, and information to be provided to the Committee, and is responsive to requests by Committee members and the Board oversight committee.
• Prepares and presents periodic reports to the PCHP Board and the Executive Leadership Team ensuring they are informed in a timely manner of all significant compliance developments, including internal and external allegations, reports of concerns, regulatory and enforcement inquiries as well as findings of internal compliance and its monitoring initiatives.
• Ensures improvements implemented as part of the requirements of the Corporate Integrity Agreement with the OIG are sustained.
• In collaboration with Talent Management and Legal Affairs enforces Parkland's Code of Conduct and Ethics through appropriate disciplinary measures.
• Maintains an effective disclosure program.
• Manages and leads investigations, documents findings, and ensures corrective actions are deployed timely and effectively for all compliance-related allegations or reports.
• Working closely with Talent Management and delegated entities, checks the Department of Health & Human Services Office of the Inspector General and General Services Administration exclusion lists quarterly with respect to all employees, officers, directors, and managers, as well as first tier, downstream and related entities.
• Oversees the integrity of the hotline process and maintains documentation for each report of potential noncompliance or potential FWA received from any source, through any reporting method (e.g., hotline, mail, or in-person).
• Ensures adherence to all HHSC obligations as outlined in the Uniform Managed Care Manual, Uniform Managed Care Contract, and other relevant documents related to compliance, ethics, and privacy.
• Research State & Federal laws and policies and apply into compliance strategies that drive results, persuades, and influences others.

Internal and External Audits

• Responsible for all internal compliance and auditing activities, which include conducting regular internal audits to ensure appropriate financial and administrative controls are in place.
• Develop and implement corrective action plans in response to audit findings and report on achievements of action plans to senior management and the Board of Directors
• Identifies potential areas of compliance vulnerability and risk and serve as the Compliance & Regulatory advisor on these matters.
• Coordinate all required documentation and audit compliance activities with the aim of ensuring timely response to requests from accrediting and/or government agencies.
• Verify the implementation of corrective action plans and monitor compliance.
• Provide leadership oversight of compliance and Fraud, Waste and Abuse (FWA) audits, ongoing monitoring, investigations, and corrective action plans.
• Supports the collection of data for regulatory filings as well as coordinate and develop reports and verify compliance through the use of assessment tools.

Training and Education

• Oversees the development and implementation of compliance education and training programs for employees, network providers (where appropriate) and management, ensuring employees understand government program responsibilities, including written standards and applicable statutory, regulatory, and other requirements.

Regulatory

• Ensures regulatory compliance with State and other government agencies related to Medicaid, CHIP, and other health insurance.
• Works closely with executive leadership to lead the development and maintenance of the Company's programs related to regulatory compliance, contract management, legal & risk maintenance, and quality improvement.
• Develop processes to maintain compliance with regulatory agencies and accrediting bodies. Ensures operations are carried out in compliance with these regulations.
• Works collaboratively with others to validate and sustain compliance with regulatory and accreditation standards.
• Conducts routine compliance audits identifying gaps and implementing remediation plans as necessary.
• Investigate and coordinate responses to matters of concern or alleged violations taking corrective action as necessary.
• Provides timely and accurate responses to requests for information from regulatory agencies and accrediting bodies.

Fiscal Management and Operating Budget

• Operationally responsible for the financial performance of assigned area(s).
• Promote activities to achieve operational efficiency.
• Manage the approved budget through frequent and regular monitoring. Implement written action plans to address variances adjusting strategies as necessary to meet budgetary targets.
• Consider operational outcomes and financial implications when making recommendations to implement new programs or modify current programs.
• Manage staffing levels within established targets.

Talent Management

• Recruit and retain diverse talent with a variety of backgrounds, skills, experiences, and viewpoints that reflect the communities we serve.
• Promote and support a culturally welcoming, inclusive, collaborative, and highly engaged work environment where everyone feels empowered to bring their full, authentic selves to work.
• Accountable for orientation, ongoing education and training, and competency verification for all employees.
• Ensure Human Resource metrics (i.e., retention, vacancy, engagement) meet established targets. Utilize workforce metrics to monitor, identify, and respond to workforce trends.
• Timely completion of employee performance appraisals.
• Conduct regular meetings, inform team of changes in policy or procedure, and provide information regarding overall strategy and direction of the health plan.
• Mentor, coach, and support direct reports with building teamwork, professional development, and education to achieve optimal performance and develop talent.
• Ensure employee engagement survey participation rates and results meet established targets.
• Mandatory requirements are completed timely by employees.
• Required licensure, certification, and/or registry are current and in good standing for all employees.
• Employee performance is monitored and managed. Consult with the Office of Talent Management as appropriate regarding employee performance concerns and disciplinary action.

Professional Accountability

• Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values.
• Adheres to organizational policies, procedures, and guidelines.
• Completes assigned training, self-appraisal, and annual health requirements timely.
• Adheres to hybrid work schedule requirements.
• Attends required meetings and town halls.
• Recognizes and communicate ethical and legal concerns through the established channels of communication.
• Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information.
• Maintains confidentiality at all times.
• Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies.

Job Accountabilities

1. Identifies and analyzes the design of jobs, work processes, workflows, etc. for the area and implements appropriate changes to improve effectiveness, productivity, and efficiency that support the overall goals of PCHP.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws, and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding.
4. Develops and monitors annual budgets that ensure the department has the necessary funds to carry out the goals and objectives that have been established for the department.
5. Develops, implements, monitors, and revises annual goals and objectives for the department that support the missions and objectives of PCHP.
6. Selects, trains, schedules, motivates, supervises, and evaluates employees making recommendations for disciplinary actions up to and including termination, to ensure maximum utilization of individual and group capabilities. Ensures that assigned employees receive opportunities to further their knowledge.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.As part of our commitment to our patients and employees' wellness, Parkland Health is a tobacco and smoke-free campus.