Licensing & Compliance Officer

Key Duties & Responsibilities:

• Regulatory Adherence:
• Stay up-to-date on all relevant federal and state healthcare laws and regulations, including but not limited to:
• Health Insurance Portability and Accountability Act (HIPAA)
• Centers for Medicare & Medicaid Services (CMS) regulations
• Stark Law and Anti-Kickback Statute
• False Claims Act
• State-specific healthcare licensing and operational regulations
• Liaise with government authorities and regulatory agencies to ensure timely submission of documentation and address any inquiries or issues.
• Licensing & Accreditation:
• Oversee the end-to-end licensing process for the hospital, including all departments, facilities, and services (e.g., pharmacy, lab, surgery centers, pathology and biomedical waste).

o    Manage all licensing applications, renewals, and updates with regulatory authorities.

• Ensure compliance with standards set by accreditation bodies (e.g., The Joint Commission).

o    Collaborate with internal departments to ensure policies and procedures comply with current regulations.

o    Maintain accurate records of all licenses, permits, and certifications.

o    Conduct internal audits to assess compliance and recommend corrective actions where needed.

o    Develop and deliver compliance training to staff.

o    Assist in responding to regulatory inquiries, audits, and inspections.

o    Prepare reports for senior management on compliance metrics and issues.

o    Stay current on changes in laws and regulations that affect the organization’s operations.

• Internal Audits & Monitoring:
• Conduct regular internal audits and risk assessments to identify potential areas of non-compliance.
• Monitor daily operations to ensure staff adherence to policies and procedures.
• Review medical billing, coding, and documentation practices for accuracy and compliance.
• Training & Education:
• Create and deliver compliance-training programs for new and existing staff across all departments.
• Educate employees on ethical standards and legal requirements, fostering a culture of compliance.
• Communicate any regulatory changes to relevant personnel and update internal policies accordingly.
• Investigation & Remediation:
• Investigate all reported or suspected compliance violations, including billing fraud, data breaches, and unethical conduct.
• Develop and implement corrective action plans to address issues and prevent recurrence.
• Serve as the primary point of contact for external audits and regulatory inquiries.
• Record Keeping:
• Maintain meticulous and up-to-date records of all compliance activities, including training records, audit results, and investigation reports.

• Collaboration:
• Work closely with hospital leadership, department heads, legal counsel, and human resources to ensure a cohesive and organization-wide approach to compliance.
• Deliverables & Accountability
  We expect that under your leadership:

• Meticulously reviewing documents, policies, and regulations and ensure accurate record keeping.
• Must demonstrate the highest level of ethical standards and professional conduct and dealing in the good faith of the hospital.
• In depth knowledge of the compliance and legal requirements of the hospital as per the state and central rules.