Compliance Coordinator

EMPLOYMENT RELATIONSHIP: Just cause subject to probationary period

CURRENT HOURS AND STARTING TIME: Full-time (37.5 hours per week) position. The starting time for this position is currently 8:30 a.m.

GENERAL SUMMARY

Under direction, manages investigations and audits for Macomb County Community Mental Health (MCCMH). Coordinates and assists in the management of departmental staff’s tasks.   Investigates complaints involving allegations of violations of ethics, Health Insurance Portability and Accountability Act (HIPAA), policy and/or fraud, waste and abuse.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

Investigates complex system issues and provides support and direction for remediation to the Compliance team.

Provides technical assistance and consultations for policy development.

Researches, analyzes, compiles and compares standards, guidelines, and requirements related to MCCMH services, categorical programs and service components.

Conducts data-mining activities and assists with the development of new algorithms.

Assists in data collection, data management, and data analysis.

Provides technical assistance and consultations for Board-level policy development.

Researches, compiles, and prepares documents, issues statements, and positions papers.

Assists in monitoring and compliance assessment activities.

Prepares reports on the status of investigations and assigns cases to staff following a preliminary investigative review.

Receives and logs compliance complaints or concerns.

Facilitates the implementation of system-wide programs, policies and procedures to ensure compliance with applicable federal and state laws and regulations, such as those for Medicare and Medicaid.

Conducts auditing and monitoring to verify compliance with standards and procedures required by federal and state laws or MCCMH.

Develops and writes policies and procedures that establish standards for compliance, giving specific guidance to management, medical staff, and departments.

Works with the Compliance Committee to communicate compliance programs, including written materials and training programs designed to specifically promote an understanding of compliance issues and the consequences of non-compliance.

Maintains an awareness of laws and regulations, keeping abreast of current changes that may affect health care systems through personal research, seminars, and peer contact.

Oversees the usage of the compliance hotline, maintaining the confidentiality of information provided to protect both the caller and the subject of the call.

Maintains a system of reporting that provides timely and relevant information on all aspects of compliance issues.

Reviews complaints, concerns or questions related to compliance issues and provides consultative leadership and support to all entities as appropriate.

Ensures that internal controls throughout the system are sufficient to provide for accurate, complete, and compliant programs and processes.

Conducts program integrity training to improve information sharing within MCCMH and to enhance referrals regarding fraud, waste, and abuse.

Operates an automobile to perform assigned job functions. 

Performs related duties as assigned.

QUALIFICATIONS

Required Education and Experience

• Bachelor's degree from an accredited college or university in Human Services, Social Science or a related field

• Two (2) years of experience in policy development, compliance assessment and evaluation, or statutory and regulatory analysis

Preferred Education and Experience

• Master’s degree from an accredited college or university in Human Services, Social Science or a related field

• Five (5) years of experience in policy development in policy development, compliance assessment and evaluation, or statutory and regulatory analysis

• Two (2) years of experience working in a mental health setting

Required Licenses or Certifications

• Possession of a valid Michigan driver’s license and operable, insured automobile for authorized travel

Preferred Licenses or Certifications

• Certification from the Health Care Compliance Association (HCCA) or the Society for Corporate Compliance and Ethics (SCCE) or related

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

• Michigan Mental Health Code and its rules and regulations

• State and federal regulations pertaining to the provision of behavioral health care services by a Prepaid Inpatient Health Plan (PIHP)

• Microsoft Windows, word processing and spreadsheet programs

• Strong written and verbal communication skills

Skill in:

• Using good professional judgment and initiative

• Excellent written and oral presentation skills

• Analyzing information and completing reports

Ability to:

• Collaborative: Approaches all situations with a teamwork and solution focused mindset demonstrated through active participation in meetings, volunteering to assist teammates and other departments as appropriate.  Examples include participation in internal and external committees, subcommittees, process improvement groups or other multi-organizational initiatives  

• Accountable: Takes ownership and empowers others to do the same as evidenced by identifying solutions and acting on job responsibilities and organizational objectives, daily  

• Respectful: Treats people with dignity while honoring individual differences demonstrated through use of positive and encouraging statements and/or interactions to, about and/or with colleagues and persons served; evidenced by supervisor observation, feedback from other department staff and leadership 

• Engages effectively with diverse communities; interact with people in an inclusive manner that respects cultural and socio-economic differences

• Work independently as well as in a collaborative team environment

• Establish and maintain effective working relationships with elected officials, Administrators, Department Heads, staff, union officials and the public

• Conduct oneself with tact and courtesy

• Work in an environment which embraces the county’s Dignity Campaign

• Effectively speak, write and understand the English language

• Effectively speak, write and understand a language other than English is preferred

• Understand and carry out oral and/or written instructions

• Accurately organize and maintain paper documents and electronic files

• Maintain the confidentiality of information and professional boundaries

• Work independently

WORK ENVIRONMENT/CONDITIONS:

The work environment and exposures described here are representative of those an employee encounters while performing the essential functions of this job.

N/S=Never/Seldom   O=Occasionally   F/C= Frequently/Continuously

Work Environment

Office or similar indoor environment: F/C

Outdoor environment: N/S

Street environment (near moving traffic): N/S

Construction site: N/S

Confined space: N/S

Exposures

Individuals who are hostile or irate: N/S

Individuals with known violent backgrounds: N/S

Extreme cold (below 32 degrees): N/S

Extreme heat (above 100 degrees): N/S

Communicable diseases: N/S

Moving mechanical parts: N/S

Fumes or airborne particles: N/S

Toxic or caustic chemicals, substances, or waste: N/S

Loud noises (85+ decibels): N/S

Blood Borne Pathogens: N/S

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.

N/S=Never/Seldom   O=Occasionally   F/C= Frequently/Continuously

Demand

Balancing on even or uneven surfaces/ground: F/C

Bending (forward or backward bending at the waist): F/C

Climbing up or down stairs, ladders, scaffolding and platforms: N/S

Crawling (moving about on hands and knees). Inspecting in confined spaces: N/S

Digging: N/S

Driving on sealed and unsealed roads: N/S

Grasping, gripping, holding, clasping with fingers or hands: F/C

Kneeling to work at low levels: O

Manual Dexterity (fine finger movements i.e., keyboard operating, writing): F/C

Lift/Carry/Move objects from one level/position to another (covered by the items below):

Up to 10 pounds: N/S

Up to 50 pounds: N/S

More than 50 pounds: N/S

Over 100 pounds: N/S

Push/Pull objects away from or towards the body: O

Reaching overhead (arms raised above the shoulder) or forward reaching (arms extended): O

Sitting in a seated position during the task performance: F/C

Standing in an upright position without movement: F/C

Walking considerable distances in the facility on multiple surfaces: F/C

Running considerable distances in the facility on multiple surfaces: N/S

GENERAL REQUIREMENTS AND DISCLAIMERS

Complies with P.A. 390, as amended, known as the State’s Emergency Management Act and the County’s Emergency Management resolution as well as all related plans, policies and procedures covered by those statutes.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by employees in this job. Employees may be requested to perform job-related tasks other than those specifically presented in this description.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.  Please tell us if you require accommodation to apply for a job or to perform your job.  Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment amongst other possible accommodations. 

GRANT OR EXTERNALLY FUNDED POSITION –This position will continue only if sufficient grant or external funds are provided.