Roles and responsibilities of the healthcare compliance manager

Compliance Manager

THE COMPANY OVERSEER

Compliance Manager in the Healthcare Industry

Job Description

The Compliance Manager oversees compliance throughout the healthcare company as an objective and independent function (ACHE, 2012). He makes sure that the board of directors, the management and all the employees thoroughly comply with the rules and regulations of regulatory agencies; that the company policies and procedures are completely followed; and the behavior in the organization follows its standards of conduct. His office receives and endorses compliance matters and issues to the appropriate person or office for investigation and implementation or resolution. It is also the final internal resource to deal with when all formal channels and resources have been exhausted. The Compliance Manager or Officer is a member of the staff of the CEO and the Board of Trustee's Corporate Compliance Committee. He monitors and reports the results of the compliance actions and provides guidance and background information to the Board and senior management on all compliance matters, issues and situations. He and the Corporate Compliance Committee are authorized to pursue all necessary actions in fulfilling the effective implementation of the compliance program of the company (ACHE).

Duties and Responsibilities

In accomplishing the objectives of his position, the Compliance Manager or Officer performs clear-cut duties and responsibilities. He develops and initiates policies and operational procedures for a healthcare compliance program to avoid illegal, unethical or improper conduct inside and outside the organization (ACHE, 2012; Scrofano, 2012). He manages the day-to-day implementation of this program, maintains and updates it on a regular basis in coordination with the human resource or personnel department. He develops, reviews and updates the organization's standards of conduct in order to keep them current and relevant in guiding management and employees. He coordinates and collaborates with the other departments in the investigation and resolution of compliance matters and issues. He consults with the company's legal counsel or attorney in the resolution of legal issues involving compliance. He acts on violations of these rules, regulations, policies, procedures and the organization's standards of conduct. He does this by evaluating the procedures or recommending investigation. He performs an independent review and evaluation of these rules and regulations, procedures and standards of conduct, focusing on issues and concerns. In doing so, he identifies vulnerable aspects and probable compliance risks and then acts proactively by instituting preventive action. If the problem aspects or issues already exist, he devises and implements corrective action. He regularly reports to the Corporate Compliance Committee of the Board and the senior management on the status of compliance in the organization. He furthermore makes sure that both actual and potential violations are reported to the duly authorized enforcement agencies (ACHE, Scrofano).

Legal and Regulatory Tasks

The Compliance Manager's comprehensive responsibility for regulatory compliance is to make sure the company or organization complies correctly and promptly with relevant federal regulations on healthcare (Scrofano, 2012). The simple objective is to avoid potential liabilities and avoid penalties, sanctions and other legal punishments. This is why he coordinates with the pertinent departments in the organization in creating and implementing organizational policies, standards and procedures, which will comply with inside and outside regulations. He also imposes standards through disciplinary policies in insuring the company's compliance of government regulations and their maintenance. Finally, the Compliance Manager establishes and maintains communication lines with decision-makers and stakeholders in keeping all involved parties informed about changes in regulations (Scrofano).

Internal Reporting

Within the company or organization, the Compliance Manager maintains reporting relationships with specific departments. He develops, initiates, implements and updates operational procedures in cooperation with the Human Resource Department (ACHE, 2012; Scrofano, 2012). He taps the cooperation of other departments in the investigation and resolution of compliance matters and issues affecting these departments and sends them progress reports. He consults and coordinates with the company's legal department or attorney in resolving legal issues involved in compliance. He regularly submits status reports to the Corporate Compliance Committee of the Board and to the senior management on the compliance situation of the organization. In cases of violations, he likewise report on both actual and potential violations to the authorized enforcement agencies (ACHE, Scrofano).

The Compliance Manager also sends reports to the Internal Auditor (Ruppert, 2006). They share similar responsibilities. Both conduct risk assessment and set risk levels; understand relevant laws and regulations; secure or identify policies for specific issues or areas; educate the organization on these policies and regulations; monitor compliance with laws, rules, regulations and policies; audit high-risk areas; and re-educate the organization on regulations and issues. If their positions are separate, the Compliance Manager's reporting relationships include the organization's board through an audit or Compliance Committee; a Board-approved program or charter authority; the organization's CEO; the entire organization, especially Compliance and internal audit professionals (Ruppert).

External Reporting

The Compliance Manager is in charge of filing certain forms and shelf registrations with the SEC (New Scientist, 2012). He also researches on, implements new accounting standards required and periodically seeks answers to technical accounting on a global sphere. The SEC documents are financial statements, which are useful for management review. He also represents the company to all regulatory authorities and fulfills all their regulatory requirements. These include disclosure documents, coordinated findings on the company's internal audits. Additionally, he facilitates external audits by regulatory agencies (New Scientist).

Ethical Issues

Many of these issues confront healthcare workers and the Compliance Manager,

depending on the specific area of the industry (Thibodeaux, 2012). Examples are a practicing doctor's dilemma about euthanasia, a health insurance agent assessing claims, conflicts of interest, distortion of medical facts, exorbitant or inconsistent billing, poor privacy, security of patient records and information and compliance with local, state and federal health regulations. Current solutions include legislation, education and stressing the guiding principle of healthcare ethics. Legislation reveals the ethical conditions occurring in the healthcare industry. An example is the Health Insurance Portability and Accountability Act of 1996. Education allows healthcare employers to offer training courses to explain ethical issues they may encounter. Penalties can be very severe for non-compliance. A worker may be suspended, fined, lose his medical license or be sued in court. The penalty depends on whether the worker violates his company's ethics policy or ethics legislation. The guiding principle of the industry is the Hippocratic Oath. It caters to the ideal that harm should not be done on another person. Some see euthanasia as merciful rather than harmful as it terminates the other person's experience of terminal or incurable pain. Others see it as harmful or evil because it terminates human life (Thibodeaux).

Career Outlook

The 2008 Bureau of Labor Statistics projected the job growth in this field to grow at an average page from 2008 to 2018 (Scrofano, 2012). It saw laws and regulations as continuing to increase and rendering it more relevant than before. But it also saw competition for this type of jobs as turning intense but for the legal practitioners (Scrofano).

Currently, the position of Compliance Manager is supervisory in nature (Ingram 2012). But it is also observed to move upward within the organization. His advantage is his large exposure to company operations and logistics. This opens him to upper management positions, such as chief operating officer if he is experienced. Legal Compliance is also becoming popular as a third-party advisory service with potentials for opening its own consulting agency (Ingram).

Compliance programs are now seen to thrive because they are projected to become mandatory (Andrews, 2011). And so will Compliance Managers or Officers. Company boards of trustees and management teams will eventually determine if their fines are too high and if the risk on them are too great to keep. The survivor in a post-reform era must deliver high quality service for low cost. Compliance programs were established in the 1990s to protect against government investigations. They were intended to function as shields or home security systems. They were to deter crime. But compliance programs of the future must deliver better patient care, dip towards the cost curve, improve employee engagement, protect and enhance the company's reputation and solve healthcare problems. They are expected to possess certain qualities. They must support company mission and values. They must be independent. They must have a clear scope. They must focus on business. They will hire only the best people. They will be more collaborative. They will be a more credible member of the leadership team. They must effect real change. Effective compliance programs will have to be an essential element of all healthcare businesses and thus become mandatory. They will become essential for their worth in the investment of the businesses (Andrews). This is the proper place of the Compliance Manager of the future and the future of his career. #