El Camino Health is committed to hiring, retaining and growing the best and brightest professionals who will carry our mission and vision forward.  We are proud of our reputation in the community: One built on compassion, innovation, collaboration and delivering high-quality care.  Come join the team that makes this happen.

Applicants MUST apply for position(s) by submitting a separate application for each individual job posting number they are interested in being considered for.

FTE

Scheduled Bi-Weekly Hours

Work Shift

Job Description

Job Description

• Monitor and analyze federal and state healthcare requirements, including HIPAA, Anti-Kickback Statute, False Claims Act, CMS Conditions of Participation, and The Joint Commission standards. Communicate developments to affected departments and support the organizational response.
• Design and conduct compliance audits and monitoring activities to assess adherence with requirements and organizational policies.
• Conduct confidential investigations of compliance concerns, complaints, and potential violations reported through the compliance hotline or other channels. Document investigation findings and recommend appropriate remedial actions.
• Assist in the development, review, and updating of compliance-related policies, procedures, and guidelines. Ensure policies align with current requirements and best practices.
• Develop and deliver compliance education and training programs for staff and management. Identify training needs based on investigations, auditing and monitoring, regulatory and industry developments, and areas of elevated risk.
• Participate in annual and ongoing compliance risk assessments. Identify emerging risks, evaluate controls, and recommend risk mitigation strategies to leadership.
• Prepare compliance reports, dashboards, and trend analyses for the Compliance Committee and senior leadership. Maintain accurate documentation of compliance activities, investigations, and corrective actions.
• Serve as a compliance liaison to clinical, revenue cycle, legal, and other departments. Provide guidance on compliance questions and support departments in developing compliant workflows.
• Review coding, billing, and documentation practices for compliance with Medicare, Medicaid, and other government payer requirements. Assist in responding to government inquiries, audits, and requests for information.
• Other duties as assigned.

Qualifications

• Bachelor’s degree in healthcare administration, business, law, nursing, or a related field required; graduate degree (JD, MHA, MBA, or equivalent) preferred.
• Minimum 3–5 years of progressive healthcare compliance experience. Strong working knowledge of applicable legal and regulatory requirements, including HIPAA and OIG Compliance Program Guidance. Experience with compliance auditing, monitoring, investigation processes, and healthcare billing, coding, and documentation requirements preferred.
• Excellent analytical, critical thinking, and problem-solving abilities.
• Strong written and verbal communication skills; ability to present complex information to varied audiences.
• Demonstrated ability to work with discretion and maintain strict confidentiality.
• Ability to manage multiple priorities and work effectively both independently and as part of a team.
• High degree of personal integrity and professional ethics.

License/Certification/Registration Requirements

• Must be Certified in Health Care Compliance (CHC) or be able to obtain the certification or equivalent within 24 months of hire.

Salary Range:

The Physical Requirements and Working Conditions of this job are available.  El Camino Health will provide reasonable accommodations to qualified individuals with a disability if that will allow them to perform the essential functions of a job unless doing so creates an undue hardship for the hospital, or causes a direct threat to these individuals or others in the workplace which cannot be eliminated by reasonable accommodation.

An Equal Opportunity Employer:
El Camino Health seeks and values a diverse workforce. The organization is an equal opportunity employer and makes employment decisions on the basis of qualifications and competencies. El Camino Health prohibits discrimination in employment based on race, ancestry, national origin, color, sex, sexual orientation, gender identity, religion, disability, marital status, age, medical condition or any other status protected by law. In addition to state and federal law, El Camino Health also follows all applicable fair and equitable employment policies from the County of Santa Clara.