PURPOSE OF JOB CLASS (NATURE OF WORK)
In the Department of Mental Health and Addiction Services, this class is accountable for overseeing and directing the DMHAS compliance program ensuring ethical and lawful conduct of all staff throughout the system of care.
Receives executive direction from the Mental Health Superintendent 2 or designee.
Directs the facility compliance officers; may lead additional staff as assigned.
EXAMPLES OF DUTIES
Directs the Agency’s compliance efforts including the administration, investigation and enforcement of the Agency’s compliance plan and policies; develops or assists in the development of related policies and procedures to comply with federal and state requirements; analyzes state and federal laws, final rules issued by federal government agencies and regulations pertinent to the healthcare environment; oversees compliance officers serving as a focal point for compliance program activities; develops agency wide compliance work plan and works with facilities compliance officers in the development of localized work plans; works with facilities and assesses risk areas; oversees the implementation, monitoring and enforcement of written policies on specific laws and program requirements; coordinates and supports monitoring and auditing procedures; reviews documentation and information relevant to compliance activities including but not limited to patient records, billing records, contract agreements, sanction screening, credentialing/verification of employee qualification, client rights, etc.; monitors agency controls as well as detect and intervene with potential compliance issues across system of care; consults with the Office of the Attorney General regarding interpretation of state and federal laws and actions, including possible infractions; promotes the compliance program through education and training; ensures compliance issues are addressed and responds to all compliance concerns; reviews and analyzes pending federal and state legislation; assists in the evaluation and development of alternative analysis and makes recommendations concerning agency program proposals, rules and policies; chairs the Executive Compliance Committee; represents and speaks on behalf of the Commissioner on all matters pertaining to compliance issues; manages compliances hot-line; performs related duties as required.
KNOWLEDGE, SKILL AND ABILITY
Considerable knowledge of and ability to apply management principles and techniques; considerable knowledge of relevant state and federal laws, statutes and regulations; considerable knowledge of the methods and procedures of research; knowledge of and the ability to apply the Health Insurance Portability and Accountability Act (HIPAA), the Health Information Technology for Economic and Clinical Health (HITECH) Act, Stark Laws, Federal Sentencing Guidelines and the anti-kickback statute; knowledge of polices administered by the Office of the Inspector General; knowledge of State document procedures; considerable interpersonal skills; considerable oral and written communication skills; considerable ability to draft policy and interpret legislation and administrative regulations, proposals and reports.
MINIMUM QUALIFICATIONS - GENERAL EXPERIENCE
Nine (9) years of professional experience in a healthcare agency with primary responsibility for the research, development, planning and review of compliance, legislative and/or regulatory programs.
MINIMUM QUALIFICATIONS - SUBSTITUTIONS ALLOWED
1. College training may be substituted for the General Experience on the basis of fifteen (15) semester hours equaling one half (1/2) year of experience to a maximum of four (4) years for a Bachelor’s degree.
2. A Master's degree in public policy, public administration, public health, health care administration, nursing or related field, or a Law degree may be substituted for one (1) additional year of the General Experience.
1. Incumbents in this class are required to obtain and maintain the HCCA Certification in Healthcare Compliance (CHC) within twelve months of employment.
2. Incumbents in this class may be required to possess and retain a valid Motor Vehicle Operator’s license.
3. Incumbents in this class may be required to travel.
JOB CLASS DESIGNATION
This replaces the existing specification for the class of DMHAS Compliance Policy Advisor in Salary Group MP 65 approved effective September 4, 2015. (Revised to modify Salary Group)