Announcement #

2024-180

Issue Date

06-14-24

Closing Date

06-20-24

Quality Assurance/Improvement Manager

Department of Tribal Health

Hourly Wage: $32.75/Regular/Full-Time

The primary function of this position is to direct and oversee Tribal Health Programs Compliance and Regulatory Support. This role involves a comprehensive understanding of compliance requirements, identification of compliance risks, and management of compliance and regulatory activities for Tribal Health and its affiliated entities. Key responsibilities include developing and implementing policies and procedures and conducting continuous internal reviews and audits to assess program effectiveness. Additionally, this position administers activities, projects, and ability to ensure compliance with Medicare and Medicaid laws and regulations. Responsibilities include planning, implementing, and overseeing all elements of an effective compliance program, such as developing and managing risk assessment and monitoring strategies, responding to compliance issues of Tribal Health programs, creating, and managing compliance workplans, coordinating external audits, and reporting to the Tribal Health Officer Deputy Director of findings and recommendations.

Examples Of Work Performed

Review and develop written policies, procedures and guidelines designed to address regulatory processes and compliance with laws and regulations and related compliance functions.

Develop training programs related to regulatory risk areas to educate employees in policies, procedures, and regulatory requirements relevant to the organization.

Lead annual risk assessments to identify regulatory vulnerabilities and risks and prioritize risks to develop and oversee compliance plan.

Lead regulatory audits and develop remediation plans for addressing deficiencies as needed and oversee implementation of corrective actions.

Create and monitor key metrics to monitor and assess effectiveness of key compliance activities and implement departmental process improvements.

Facilitate quarterly compliance committee meetings and summarize/report to leadership.

Proficiency with HIPAA regulatory affairs.

Proficiency in employment regulatory concepts.

Develop and execute a strategy for a sustainable Medicare Compliance Program that is effective and efficient.

Manage, document, and maintain a coordinated regulatory Government Programs Compliance Program that meets the expectations of State and Federal regulators and corporate governance programs.

Develop and implement program policies, procedures and practices designed to promote compliance with the requirements of State and Federal health care programs. Also develop and implement policies and procedures that implement components of the compliance program.

Work with business unit leaders to increase awareness of the importance of the Compliance Program and develop and maintain positive relationships between compliance and operations staff.

Manage the compliance unit's administrative duties organizing and maintaining relevant documents; preparing necessary reports on activities; and supervising support staff, as needed. Monitor Compliance performance by operational areas. Undertake investigations of compliance inquiries, prepare reports, and monitor remediation.

Collaborate with the Tribal Health Management Team and Human Resources department to develop strategies and positions regarding regulations, contracts, employment matters, and litigation.

Advise on regulatory actions and liaise with regulatory counsel when necessary.

Draft and review contractual (PL 638) agreements for specific programs to ensure overall legal compliance.

Stay abreast of changes in laws and regulations impacting the organization and provide guidance on compliance implications.

Provide support during operational changes, ensuring smooth transitions and effective adaptation.

Ensure timely and accurate documentation of annual competency assessments for personnel, in accordance with the requirements set forth by CLIA, and DOH.

Stay updated on industry trends, advancements, and changes in regulatory requirements, and implement necessary updates to ensure continuous improvement.

Maintain accurate and up-to-date records of quality assurance activities, including audit findings, corrective actions, and quality control results.

Develop and revise standard operating procedures (SOPs) to enhance efficiency, accuracy, and compliance with regulatory requirements.

Performs on-going audits to identify opportunities for improvement and monitor compliance with regulatory requirements. Participates in the development and implementation of appropriate plans of action to correct identified areas of improvement. Ensures action plans completed timely and adequately address the identified concern and develops and facilitates training programs and orientation for team members to the QAPI process and regulatory guidelines.

Develop and implement compliance policies, procedures, and protocols tailored to the specific needs of the medical clinic.

Reviews policies and procedures, clinical and non-clinical, companywide.

Serves as the HIPAA Privacy Officer; oversees medical record request process.

Oversees third-party billing audits to ensure compliance with relevant rules and regulations.

Conducts internal audits to ensure compliance with Stark, Anti-kickback, Conflicts of Interest, Fraud, Waste and Abuse, and other relevant laws and regulations.

Conduct regular audits and assessments to identify compliance risks and areas for improvement, including billing and coding practices, patient privacy, and quality of care.

Collaborate with clinic management and staff to address compliance issues and implement corrective actions as necessary.

Monitor changes in healthcare laws and regulations, updating policies and procedures accordingly to maintain compliance.

Investigate allegations of non-compliance, including incidents of fraud, waste, or abuse, and take appropriate disciplinary or

corrective measures.

Provide training and education to clinic staff on compliance-related topics, such as HIPAA regulations, fraud prevention, and documentation requirements.

Maintain documentation of compliance activities, including audit findings, investigations, training sessions, and policy updates.

Serve as the primary point of contact for regulatory agencies, responding to inquiries, requests for information, and audits.

Develop and maintain relationships with external partners, such as legal counsel, professional organizations, and industry associations, to stay informed of best practices and emerging compliance issues.

Prepare reports for clinic management and governing bodies on compliance activities, trends, and outcomes.

Lead or participate in compliance committees and initiatives aimed at promoting a culture of compliance and ethical behavior within the clinic.

Stay current on industry trends and developments in healthcare compliance through ongoing professional development and networking.

Other duties and projects as assigned.

Knowledge, Skills And Abilities

Demonstrated knowledge of government regulations as they relate to the administration of Medicare healthcare programs, principles, and practices of managed care. Strong subject matter expertise in Medicare Operations and Compliance Requirements.

Proven ability to work with all levels of leadership. Demonstrated effectiveness operating in complex organizational environments. Demonstrated ability to partner effectively with others in handling complex issues.

Project coordination and management experience. Strong experience with Medicare health care products is preferred.

Strong people leadership skills with ability to lead cross functional teams.

Strong research, analytical, writing, public speaking, and computer skills. Excellent written, oral, and presentation communication skills.

Ability to develop and support staff in their professional development and inspire excellence.

Strong problem-solving skills.

Understanding of health policy issues related to medical and other healthcare activities.

Proficiency in identifying, analyzing, and resolving complex problems and challenges using logical reasoning, data analysis, and creative solutions.

The capability to convey information clearly, concisely, and persuasively, both orally and in writing, to diverse audiences while fostering open dialogue and understanding.

The ability to meticulously review and maintain accuracy in tasks, ensuring thoroughness and precision in all aspects of work to minimize errors and achieve high-quality outcomes.

The capability to assess situations objectively, analyze information critically, and make sound decisions based on thorough evaluation and reasoned judgment.

Persistence to ensure that all operations are pragmatic and effectively meet quality standards.

Excellent oral, written and presentation communication skills. In addition, must have strong interpersonal skills, including comfort communicating across all departments and with a remote and distributed team.

Embrace both interpersonal and operational flexibility and versatility.

Knowledge of digital health technologies and/or digital therapeutics.

Knowledge of medical device reimbursement, health care compliance, HIPAA, and information security

Minimum Requirements

Bachelor's degree in healthcare administration, public health, or a related field (Master's preferred).

Minimum of 2 years of experience in quality assurance, compliance, and regulatory affairs in healthcare settings, including people management, compliance-related activities, legislative and regulatory activities, health insurance operations, or legal research, or an equivalent combination of education and experience.

Must pass a pre-employment background check.

Must possess a valid Washington State Driver's License with the ability to obtain a Yakama Nation Driving permit.

Required to pass a pre-employment drug test.

Preferred Requirements

Enrolled Yakama Preference, but all qualified applicants are encouraged to apply.

Yakama Nation Legends Casino

New Jobs

Quality Assurance/Improvement Manager