Jurisdiction: Cortland County

Jurisdictional Class: Competitive

Adopted: 7-28-11

COMPLIANCE OFFICER

DISTINGUISHING FEATURES OF THE CLASS:

The Compliance Officer oversees the Corporate Compliance Program, functioning as an independent and objective body that reviews and evaluates compliance issues/concerns within the Mental Health organization. The position ensures the Community Service Board, agency management, and employees are in compliance with the rules and regulations of regulatory agencies, that agency policies and procedures are being followed, and that behavior in the organization meets the county and departmental Standards of Conduct. Does related work as required.

TYPICAL WORK ACTIVITIES: (Illustrative only)

Develops, initiates, maintains, and revises policies and procedures for the general operation of Cortland County Department of Mental Health Programs to be consistent with expectations of regulatory agencies, the Corporate Compliance Plan and its related activities to prevent illegal, unethical, or improper conduct;

Develops and facilitates training for employees related to corporate compliance issues and policy;

Participates in the agency process of Utilization Review to ensure timely and appropriate documentation for billing;

Develops, revises, and maintains process to respond to and track grievances and incident reports. Manages local and state reporting processes whenever appropriate;

Manages process to orient and screen new employees related to the rules of the Office of Mental Health (OMH) for background checks. Keeps record of background checks and updates and maintains online Criminal Information Tracking System;

Develops and periodically reviews and updates Code of Ethics to ensure continuing currency and relevance in providing guidance to management and employees;

Collaborates with other departments (e.g., Human Resources, Health, Information and Technology) to direct compliance issues to appropriate existing channels for investigation and resolution. Consults with the County Attorney as needed to resolve difficult legal compliance issues;

Responds to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct by evaluating or recommending the initiation of investigative procedures. Develops and oversees a system for uniform handling of such violations;

Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future;

Provides reports on a regular basis, and as directed or requested, to keep the Corporate Compliance Committee of the Board and senior management informed of the operation and progress of compliance efforts;

Monitors the performance of the Compliance Program and relates activities on a continuing basis, taking appropriate steps to improve its effectiveness;

Provides advice, consultation and assistance on medical record matters to department management and staff by serving as a member of the agency Administrative Team, Utilization Review Committee and Chairing the Mental Health Clinic Committee for Continuous Quality Improvement.

FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES AND PERSONAL CHARACTERISTICS:

Good knowledge of the principles, methods and practices of Corporate Compliance.

Good knowledge of the policies and regulations of the Office of Mental Health.

Good knowledge of pertinent Federal, State, Departments and accrediting agency, legal and policy requirements and regulations relating to the maintenance and release of medical records information;

Working knowledge of departmental policies and procedures;

Ability to establish and maintain effective working relationships with clinical staff;

Physicians and other departmental staff;

Ability to establish and maintain effective working relationships with outside agencies such as the Courts, Probation, Department of Social Services, etc.;

Ability to recognize inconsistencies and omissions in medical records;

and accurate medical records;

Physical condition commensurate with the demands of the position.

MINIMUM QUALIFICATIONS: Graduation from a regionally accredited college or university or one accredited by the New York State Board of Regents to grant degrees with a Bachelor’s degree or higher and two (2) years of full-time paid work experience in the maintenance, review and development of policies and procedures to support Corporate Compliance.