Job Description

Job Description

Job Description

Description:

The primary responsibility of the Compliance Officer is to manage and promote a strong compliance program across all areas of the organization, ensuring adherence to regulatory requirements. This role oversees the compliance operations and department, manages the Compliance Plan, and acts as a trusted and objective resource for reviewing and evaluating compliance issues within the organization.

This role will collaborate with Galen Medical Group’s leadership team, physicians, and department managers to strategize, develop, and implement effective compliance policies that align with the mission and organizational goals. Efforts will ensure adherence to regulatory requirements and internal standards while promoting best practices to maintain a strong culture of compliance.

In addition to core compliance responsibilities, this position also serves as Galen’s designated Privacy Officer under HIPAA. Specific responsibilities related to this designation are detailed in a separate addendum to this job description.

Essential Functions:

• Lead the development, implementation, and oversight of the organization's Compliance Program to ensure adherence to applicable federal and state healthcare regulations within a physician practice environment.
• Oversee compliance operations across multiple specialties and clinical sites, including policy development, fraud and abuse prevention efforts, and daily monitoring activities.
• Direct and manage internal investigations of compliance concerns or violations, including oversight of the compliance hotline and proper documentation of outcomes.
• Monitor regulatory updates and developments (e.g., CMS, OIG, OSHA, CLIA, state-specific healthcare laws) and ensure timely updates to internal policies and training materials.
• Collaborate with Human Resources and department leadership to design and oversee a comprehensive compliance education program, including onboarding and ongoing training for clinical and administrative staff.
• Conduct and coordinate internal compliance audits and risk assessments related to billing, coding, patient access, and medical documentation practices.
• Maintain and update compliance policies and procedures, including the Standards of Conduct, to reflect current regulatory requirements and operational needs. Collaborate with relevant department leaders to ensure policies are clearly communicated, accessible, and consistently applied.
• Regularly evaluate the Compliance Plan and provide structured reports and recommendations to executive leadership.
• Ensure that all reported compliance concerns are tracked in an internal compliance activity log, complete with documentation and clear resolution steps.
• Partner with legal counsel, Revenue Cycle, and administrative leaders to review contracts, vendor agreements, and physician arrangements for regulatory compliance, including the Stark Law and Anti-Kickback Statute.
• Investigate patient complaints related to regulatory or ethical issues, including Section 1557 non-discrimination concerns, and coordinate with department leaders on corrective actions.
• Partner with Human Resources to ensure that the outcomes of compliance investigations are addressed in a manner consistent with organizational policy and applied fairly across the organization.
• Serve as the primary point of contact for external auditors and regulators regarding compliance inquiries, ensuring timely and accurate organizational responses.

Supervisory Responsibilities:

• Lead, train, and develop the compliance team to align with organizational goals and drive successful outcomes.
• Oversee department resources, ensuring staff have the tools, training, and support needed for effectiveness.
• Foster a collaborative team environment that promotes professional development, knowledge sharing, and compliance excellence.

Other Duties/Responsibilities:

• Uphold and promote the mission, vision, and values of Galen Medical Group.
• Represent the organization professionally while adhering to HIPAA guidelines and maintaining patient confidentiality.
• Follow all organizational policies, procedures, and compliance standards.
• Engage in performance improvement, quality initiatives, and team collaboration.
• Participate in meetings, training, and other assigned duties as needed.

Knowledge/Skills/Abilities:

• An ability to prioritize effectively and exercise sound judgment in a fast-paced, physician-driven environment.
• Demonstrated ability to work effectively and congenially with employees at diverse levels
• Proficient in records management, data entry, word processing, and office equipment use.
• Strong communication skills, including writing, editing, and verbal interaction.
• Skilled in scheduling, calendar management, and task coordination.
• Detail-oriented, able to follow instructions, multitask, and work independently.
• Maintains professionalism in challenging situations and fosters a positive work environment.
• Upholds ethical standards, policy compliance, and adherence to OSHA, HIPAA, and CLIA regulations.

QUALIFICATIONS:

Education:

• Master's degree or equivalent in clinical healthcare, risk management, law business, or a related field is preferred
• Bachelor's degree or equivalent in clinical healthcare, risk management, law business, or a related field is required.

Certifications:

• A current Certification in Healthcare Compliance (CHC) is required.
• Preferred additional certifications include, Certified in Healthcare Privacy and Security (CHPS), Health Care Compliance Association (HCCA) Certification, or HIPAA Certifications.

Experience:

• Minimum of 5–7 years of healthcare compliance experience in a multi-specialty medical group, physician practice, or outpatient care setting.
• Minimum of 3 years of experience in a leadership or management role, overseeing compliance operations, staff development, and departmental strategy.
• Familiarity with EHR systems, billing practices, and operational workflows in outpatient healthcare environments.
• Demonstrated ability to conduct and oversee investigations into regulatory violations, fraud, waste, abuse, and patient complaints, including 1557-related issues.

Galen Medical Group is a member of the TN Drug-Free Workplace, and it is a requirement that we conduct a pre-employment drug screen as part of the hiring process.

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