Compliance Officer​/Sr. Compliance Officer; Hybrid

Overview

Job Description - Compliance Officer/Sr. Compliance Officer (Hybrid). Compliance Officer/Sr. Compliance Officer (Hybrid) - (25000B3U). This position, under the direct supervision of the Compliance Supervisor or Director and the Chief Compliance Officer, works closely with key stakeholders to implement elements of the UH Compliance and Ethics Program to ensure compliance with new and existing federal, state, and local laws and regulations affecting University Hospitals Health System.

• For assigned areas, perform ongoing activities related to the development, implementation, maintenance of, and adherence to UH policies and procedures and applicable federal, state, and local laws, rules, and regulations. Chair and coordinate meetings for assigned Compliance Committees; develop and implement compliance activities with oversight of the UH Compliance and Ethics Department; assess compliance-related controls, measurement criteria, and monitoring activities.
• Identify areas of potential compliance risk and take appropriate measures to resolve that risk.
• Foster an environment of open communication so employees can report compliance concerns, questions, or problems without fear of retaliation.
• Evaluate compliance program activities in assigned areas and institute changes to reflect current laws, regulations, and best practices.
• Evaluate compliance risk in assigned areas to recommend specific activities and initiatives for inclusion in the UH annual compliance work plan.
• Ensure that each assigned area has internal controls, monitoring, and auditing procedures in place for consistent compliance processes.
• Coordinate and integrate activities and analyses into the assigned area’s quality and risk management program.
• Assist with the execution of the annual compliance work plan for each assigned entity, aligned with the UH annual compliance work plan.
• Function as the assigned entities’ Compliance Officer or HIPAA Privacy Officer, as applicable.

• For the assigned areas, investigate and document all reported compliance issues. Communicate issues to the appropriate Director and/or Chief Compliance Officer; respond to inquiries and investigations in a timely manner, including issues reported through the UH Compliance Hotline; maintain documentation of investigations and corrective actions.
• Identify trends in compliance issues and use findings to design or redesign systems, policies, procedures, and training to enhance consistent compliance.

• Educate personnel about the UH Compliance and Ethics program. Periodically assess education needs, develop training materials, and facilitate training related to compliance responsibilities. Disseminate compliance information or updates to appropriate individuals within assigned areas.

• Ensure integration and compliance with UH policies and procedures. Attend Compliance and Ethics departmental meetings, participate in system activities and processes, and identify opportunities to enhance compliance.
• Participate in periodic compliance strategic planning and effectiveness evaluations.
• Stay apprised of compliance and regulatory developments, including OIG guidance, CMS updates, Stark Law, Anti-Kickback Statute updates, and related regulatory changes.

• Lead the day-to-day functions of the UHHS Conflicts of Interest Program (COI Program): manage data collection, prepare conflict management reports for leadership, assess disclosures, and coordinate COI education. Collaborate with research departments to ensure compliance with UHHS COI policies and applicable regulations.
• Monitor and coordinate the Civil Rights Compliance Program: ensure compliance with federal and state regulations and nondiscrimination laws; develop and update annual implementation plans; advise on procedures and investigate complaints alleging discrimination.
• Collaborate with department leadership to develop and execute UH’s culture of compliance strategy; support ethical decision-making, develop training plans, and promote engagement with compliance and ethics initiatives.
• Performs other duties as assigned; complies with all policies and standards; refer to department documentation…