Cook County Health · 2 days ago
COMPLIANCE OFFICER - CountyCare
Cook County, IL
Full-time
Onsite
Mid, Senior Level
3+ years expCook County Health is dedicated to providing high-quality healthcare services, and they are seeking a Compliance Officer for CountyCare. The Compliance Officer is responsible for the development and implementation of the Health Plan compliance program, ensuring adherence to regulatory standards, and managing compliance training and investigations.
Health CareHospital
Responsibilities
Collective Bargaining Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Discipline Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Supervision Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Management Contribute to the management of CCH staff and CCH systemic development and success
Discuss and develop CCH system policies and procedures
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary: hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Governs of the Health Plan’s Fraud, Waste, Abuse (FWA) and Financial Misconduct Program (Program Integrity Program) including delegated Special Investigations Unit (SIU) to ensure that Program Integrity Program and FWA initiatives are actively administered and addressed, as delegated by the Chief Corporate Compliance & Privacy Officer
Implements and coordinates communication protocols and methods that encourage CCH workforce/employees, independent contractors, and delegated vendors to report issues related to noncompliance and FWA without fear of retaliation
Coordinates and oversee fraud investigations and referrals conducted by delegated SIU’s, where applicable
Collaborates with other Medicaid health plans, HFS, the HFS Office of Inspector General, Medicaid Fraud Control Units (MCFUs), local law enforcement, commercial payers, and other organizations, where appropriate, when a potential FWA issue is discovered that involves multiple parties
Ensures that FWA is reported in accordance with federal, state and local requirements, as well as the guidelines in the Medicaid Managed Care regulations at 42 CFR 438.608 and the CCH Managed Care Community Network (MCCN) Agreement with Illinois Department of Healthcare Family Services (HFS)
Serves in a leadership capacity to develop the Health Plan compliance program in conjunction with the Chief Corporate Compliance & Privacy Officer
Chairs and facilitates the executive Regulatory Compliance Committee meeting on a quarterly basis
Develops, implements, maintains, and assesses/updates compliance policies and procedures to ensure adherence with relevant regulatory and requirements
Modifies health plan policies, procedures, and projects to reflect changes in laws and regulations
Establishes a structured process for regulatory review, monitoring, and dissemination of information
Reviews health plan agreements, contracts, addenda, and other relevant documents, as needed
Oversees, directs, delivers, tracks, or ensures delivery of compliance training and communications, both general in nature and specialty, for employees, workforce, network providers, vendors, and consultants
Aligns with Health Plans’ operations regarding sanction/exclusion checks to verify that CountyCare network providers, employees, workforce, vendors, and consultants (where necessary) are screened against applicable Federal and State sanction and exclusion lists
Coordinates with Health Plan provider network contracting to ensure new providers undergo a FWA review
Establishes and administers a process for receiving, documenting, tracking, investigating, and taking action on all compliance concerns
Investigates reports of alleged non-compliance to determine the validity, nature and scope of the report in conjunction with the designated team members, as identified by the Chief Corporate Compliance & Privacy Officer
Performs interviews with key personnel to validate compliance with established policies and procedures and applicable regulations in conjunction with reports of alleged non-compliance, as deemed necessary
Develop reports upon completion of each compliance review, which details recommendations designed to correct any potential weaknesses or areas of non-compliance discovered during the review
Performs follow-Up reviews to ensure action plans have been adequately implemented
Collaborates with operational areas to remediate concerns through action plans to correct potential weaknesses and assure ongoing compliance
Develops and coordinates compliance projects with CCH entities, which may be ad-hoc or delineated in the Compliance Program Annual Work Plan and perform prospective reviews in conjunction other personnel as deemed necessary, and as requested by the Chief Corporate Compliance & Privacy Officer
Develops vendor-specific annual audit protocols, performs audits, review results, and determines if regulatory and requirements requirement are met
Produces and delivers Compliance Program reports for CCH and Health Plan Leadership, , the Board of Directors, and/or the Audit and Compliance Committee of the Board of Directors, as directed by the Chief Corporate Compliance & Privacy Officer
Collaborates with Health Plan Leadership to facilitate operational ownership of compliance
Monitors operational management of the Health Plan complaint, grievance, appeals and fair hearing processes for program compliance including review of trends and patterns through reports and data analysis
Maintains highest levels of confidentiality regarding all departmental operations in both verbal and written and with the use of technology
Works with minimal supervision and use time effectively
Maintains a high degree of follow-through despite frequent interruptions
Performs other duties as assigned
Qualification
Required
Master's degree from an accredited college or university
Three (3) years of conducting complex healthcare analysis and/or investigations
Leadership competencies to include planning and organizing, problem solving, informing, consulting, supporting, and networking
Knowledge of coding, billing, medical records, review/analysis, and documentation
Preferred
Master's degree or higher in Healthcare, Business, Education, or related field from an accredited college or university
Juris Doctor (J.D.)
Professional Registration/Certification or compliance/fraud related healthcare credentials, current & active, including but not limited to RHIA, CPA, CFE, AHFIm CFE, HIA, HCAFA, MHP or CHC
Project Management experience
Five (5) years recent managerial/supervisory experience in a health plan, hospital or a large multi-specialty clinic setting with experience in the areas of compliance, audit, risk, quality and/or legal
Health plan experience
Benefits
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
Company
Cook County Health
Cook County Health is the safety net for health care serves as the primary public provider of comprehensive medical services.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Kaiser Permanente Center for Gun Violence Research and Education
2024-05-21Grant
Leadership Team
Erik Mikaitis
Chief Executive Officer
Recent News
GlobeNewswire
2026-01-02
Cook County Health
2025-09-17
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