Under the direction of the Compliance Officer (CO), the Director of Compliance is responsible for the direction and management of all areas under their leadership which may include quality, compliance, privacy, and HIM for any of the Avow companies, all Avow compliance programs and associated work plans.  

Essential Job Functions:

Detects and evaluates risks.

Strong understanding of Hospice/Homecare. 

Ensures that risks are minimized by following-up and acting on regulatory survey report recommendations/deficiencies in collaboration with the other departments.

Under the direction of the CO implements, oversees and manages the corporate compliance program(s).

Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions.  

Assists the organizations leaders to resolve compliance issues in a timely manner to avoid any incidence of potential fraud, abuse, waste or neglect.

Keeps current with and communicates relevant information from the Office of the Inspector General (OIG), Florida Agency for Healthcare Administration (AHCA) regulations, fraud alerts and advisory opinions.

Ensures that the organization’s Compliance and Ethics Programs are updated regularly as needed, provides for training for Board, volunteers and staff on the program and that the program is always in accordance with current law, regulations and best practices.

Plans and manages Avow’s compliance and audit program(s) in accordance with directives and priorities of the CO.

Encourages all employees, volunteers and direct patient care contractors to report any suspected compliance or ethical breaches for investigation without fear of retaliation.
Investigates all reports and presents findings to appropriate parties.

In collaboration with the CO, utilizes external resources such as regulatory attorneys and compliance consultants to assist with guidance related to follow up on reported issues. Tracks in compliance tracking logs.

Reads, analyzes, summarizes, reports and recommends to organizational leaders any proposed and new federal and state regulations and Joint Commission standards and other pertinent specialty accreditation requirements to provide direction for the company response.

Maintain a working knowledge of current and proposed laws, regulations and guidelines.
Reviews compliance activities and collaborates with the clinical operations leaders, in developing action plans for areas identified as non-compliant.

Recommends to the Leadership Team methods to improve efficiency and quality of services to reduce vulnerability to fraud, abuse and waste.  

Serves as key contact person to leaders responsible for compliance and assigned standards and other regulatory requirements.

Under the direction of the CO conducts, on a regular basis, the Enterprise Risk Management process with the Executive Leadership Team.

Designs and implements annual Audit plan(s) for the organization in conjunction with the operations leaders to focus on areas of concern or priority elicited from previous audits, compliance concern reports/investigations, OIG Work Plan, ERM Tools, staff education and documentation learning need trends, new regulations and high risk areas.

Manages the organization’s Compliance Committee. 

Identifies high-risk areas to reduce the agencies vulnerability to fraud and abuse. 

Monitors the organizations PEPPER report and NCLOS rates reporting results to the CEO and CO.

Identifies and monitors developments and trends in internal operations and external regulatory environments to assess risk and compliance impacts and implements best compliance practices.

Under the direction of the CO, responsible for ensuring processes are in place to monitor and evaluate safety and risk management.

Implements corrective action plans for resolution of problematic areas and provides general guidance on how to avoid, mitigate, or address similar situations.

Develops and oversees the organization’s written audit Work Plan(s) to identify and address learning needs, improve performance and maintain compliance. Reports trends, high risk areas and action plans and adjusts the audit plan on an ongoing basis as needed to the CO and CEO.

Maintains updated knowledge and expertise in health information record management, documentation requirements for all clinical disciplines and external collaborative practitioners such as referring physicians, long term care facilities, hospitals, etc.

Fosters collaboration with IT department and external parties’ electronic records systems to enable integration, improve information sharing and maintain patient information privacy standards

Provides expert clinical resource in health information coding to maximize compliance with documentation requirements and billing capacity and compliance with third party payers.

Provides for collaboration with Billing, Service Integrity and IT departments and documentation consultants to ensure best practices related to clinical documentation are being implemented.

Participates in survey and survey initiatives including Mock Surveys.

Provides back up support to the CO and Service Integrity Team,. 

Provides assistance in continuously designing, developing, and improving processes based on identified opportunities for improvement, and coordinates and follows up as necessary.

Identifies areas and processes that can be conducted more efficiently through use of system applications and, recommends and implements changes
Initiates and recommends policy and procedure changes

Serves on various committees

May directly supervises the HIM supervisor maintaining oversite of HIM and providing health information records management and support

Ensures the collection of data and maintenance of the physician license verification database and directs performance audits to assess compliance with licensing requirements 

Ensures the ongoing maintenance of HIM tracking databases for compliance with regulatory and legal requirements

Initiates or participates in the development of medical records systems or new processes that reflect increased efficiency, productivity and/or quality in Health Information Management

Maintains tracking system for Medicare or other insurance audits through all systems of appeals

Develops and implements new processes that reflect increased efficiency and productivity throughout departments

Facilitates the activities of on-site and remote auditors, surveyors and consultants to ensure they receive requested information and follow up

Maintains regulatory and legal requirements related to health information and communication within the organization 

Ensures the maintenance of data integrity, tracking and reporting to support clinical and organizational processes 

Ensures annual updates to the Comprehensive Emergency Management Plan and submission to regulatory agencies as required by regulation

Key leader on the Emergency Management team

Tracks and monitors statistical data, quality indicators and maintains reports that support standards of care and program management

All other duties as assigned

Core Values:

Innovation:

We embrace change and are always looking at creative ways to solve problems and serve new populations.

Integrity:

We are honest, hardworking, fiscally responsible professionals driven solely by the well-being of our patients, their loved ones, and the communities we serve.

Collaboration:

We know we cannot achieve everything we want without working hand-in-hand with each other, with our healthcare partners, and with the community.

Celebration:

We believe in the importance of celebrating life and relationships.

Education:

We believe it is important not only to serve the community but to educate community members about our services and the role we can play at the end of life.