Applications are now closed for this position
Leading provider of affordable Health Insurance cover in South Africa requires a Compliance Officer in the Executive office.
Tasks
Overseeing and monitoring the implementation of the compliance program.
Reporting on a regular basis to the governing body and leadership (medical group, medical school and hospital), CEO and compliance committee on the progress of implementation, and assisting these components in establishing methods to improve efficiency and quality of services and to reduce the vulnerability to fraud, abuse and waste.
Periodically revising the program in light of changes in the needs of the organization, and in the law and policies and procedures of government and private payer health plans.
Developing, coordinating and participating in a multifaceted educational and training program that focuses on the elements of the compliance program, and seeks to ensure that all appropriate employees and management are knowledgeable of, and comply with pertinent federal and state standards.
ensuring through purchasing that independent contractors and agents who furnish medical services to the health system are aware of the requirements of the compliance program with respect to coding, coverage, billing and marketing, among other things.
Ensuring through the human resources office, the dean;s office, the purchasing department and the credentialing office that the Cumulative Sanction Report and GSA Excluded Parties System have been checked with respect to all employees, medical staff and independent contractors.
Coordinating internal compliance review and monitoring activities, including periodic reviews of departments.
Responding to government investigations and queries as the principal point of contact.
Competencies
Independently investigating and acting on matters related to compliance, including the flexibility to design and coordinate internal investigations (responding to reports of problems, “hot-line” calls, or suspected violations) and any resulting corrective actions with all health system departments, providers and sub-providers, agents and, if appropriate, independent contractors.
Developing policies and programs that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
Qualifications
Matric.
Remuneration
(Negotiable) P/A