About this role
1. Reports to the Chief Compliance Officer.
2. Review all payor requirements, such as National Coverage Determinations and Local Coverage Determinations and develop a plan to operationalize the requirements within the system to ensure compliance.
3. Oversees payors requirements to assure compliance with federal and state healthcare rules and regulations.
4. Partner and collaborate with Department and Senior Leadership to assure compliance with federal and state healthcare rules and regulations.
5. Conduct routine audits to assure compliance with regulatory requirements,
6. Routinely train and educate on federal and state payor healthcare rules and regulations, Compliance Work Plan and Cape Cod Healthcare policies and procedures
7. Prepare and provide reports routinely to the Chief Compliance Officer, Compliance Committee and Senior Leadership as required.
8. Create and manage any corrective action plan due to gaps and/or non-compliance identified.
9. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
10. Challenges current working practices identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
11. Other duties as needed.
• Graduate of an accredited School of Nursing, Advanced degree preferred.
• Must have 5+ years of Healthcare Compliance experience.
• Must hold or obtain in 2 years a Certified in Health Care Compliance (CHC) certification.
• Understanding and knowledge of healthcare payor rules and requirements
• Ability to evaluate and educate on healthcare regulatory requirements.
• Knowledgeable of OIG’s Seven Element of a Successful Compliance Program and US Federal Sentencing Guidelines
• Prior experience presenting multiple levels of healthcare.
• Previous Compliance Integrity Experience preferred.
• Certification in healthcare compliance a plus.
• Ability to read, write and communicate in English
Other facts
About Cape Cod Healthcare
Cape Cod Healthcare is the leading provider of healthcare services for residents and visitors of Cape Cod. With more than 600 physicians, over 5,000 employees and over 250 volunteers, Cape Cod Healthcare is comprised of two acute care hospitals, a Level III trauma center, the Cape’s leading provider of homecare and hospice services (VNA), seven urgent care centers, a primary and specialty care network, a skilled nursing and rehabilitation facility, an assisted living facility, and numerous health services and programs.
We are committed to achieving and maintaining the highest standards in healthcare by partnering with other health and human service providers and continuing to invest in new technologies. By offering services like imaging and radiology, heart and vascular care, surgical services, orthopedics and urgent care, Cape Cod Healthcare provides access to exceptional medical services across the Cape.
For over a century, we have never wavered from our mission: To coordinate and deliver the highest quality, accessible health services, which enhance the health of all Cape Cod residents and visitors.
What you'll do
- The Executive Director, Compliance will oversee payor requirements and ensure compliance with federal and state healthcare regulations. This role includes conducting audits, training staff, and preparing reports for senior leadership.
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