The Chief Compliance and Quality Officer (CCQO) provides executive leadership and oversight of the organization’s Corporate Compliance Program, Risk Management Program, quality reporting activities, and regulatory readiness efforts. This position ensures compliance with applicable federal, state, local, HRSA, HIPAA, Medicare, Medicaid, and FQHC regulations while supporting organizational performance through quality measures, regulatory standards, and patient safety initiatives.
As a member of the Executive Leadership Team, the CCQO collaborates with clinical, operational, financial, human resources, and information technology leadership to foster a culture of compliance, accountability, patient safety, and operational excellence.
- Direct, implement, monitor, and evaluate the organization’s Corporate Compliance Program.
- Ensure compliance with applicable federal, state, and local healthcare regulations, including HRSA requirements, HIPAA, Medicare, Medicaid, OSHA, and OIG guidance.
- Develop and maintain compliance policies, procedures, standards, and the organization’s Code of Conduct.
- Develop and manage the annual Compliance Work Plan and conduct ongoing compliance risk assessments.
- Conduct compliance audits and investigations to identify areas of risk, non-compliance, or operational vulnerability.
- Develop and monitor corrective action plans to ensure timely resolution of identified compliance issues.
- Oversee contract compliance, business associate agreements, conflict-of-interest requirements, and applicable Stark Law, Anti-Kickback Statute, and False Claims Act requirements.
- Coordinate exclusion screening of employees, contractors, vendors, and Board members against applicable federal databases.
- Manage confidential compliance reporting mechanisms and serve as liaison with regulatory agencies, auditors, legal counsel, and external consultants as needed.
- Monitor, analyze, and report organizational quality metrics and performance indicators.
- Track UDS, HEDIS, CMS, value-based care, and other regulatory or payer-required quality measures.
- Ensure the accuracy, integrity, validation, and timely submission of required quality reports.
- Conduct chart reviews, audits, and data analysis to identify compliance, quality, and performance trends.
- Provide leadership with actionable reports and dashboards to support clinical and operational decision-making.
- Collaborate with department leaders to address performance variances, regulatory requirements, and opportunities for continuous improvement.
- Bachelor’s degree in Informatics, Health Informatics, Data Science, Data Analytics, Healthcare Administration, Business Administration, Compliance, Quality Management, or a related field required; Master’s degree preferred.
- Minimum of five (5) years of progressive healthcare compliance, quality, risk management, or related leadership experience preferred.
- Experience within a Federally Qualified Health Center (FQHC), community health center, or similar healthcare environment strongly preferred.
- Demonstrated knowledge of medical billing, coding, documentation requirements, revenue cycle operations, and payer regulations required.
- Experience conducting coding and billing compliance audits and ensuring compliance with ICD-10-CM, CPT, HCPCS, Medicare, Medicaid, and commercial payer guidelines required.
- Experience developing and providing compliance and regulatory education to staff, providers, management, and Board members preferred.
- Strong knowledge of healthcare compliance, risk management, quality improvement, patient safety, and regulatory requirements.
- Knowledge of HRSA, FQHC, HIPAA, OIG, Medicare, Medicaid, and other applicable healthcare regulations.
- Strong leadership, analytical, auditing, investigation, and problem-solving skills.
- Excellent written and verbal communication skills with the ability to communicate regulatory and compliance requirements across all levels of the organization.
- Ability to maintain confidentiality, exercise sound judgment, and handle sensitive compliance matters with professionalism and discretion.
- Ability to analyze quality and compliance data and translate findings into actionable organizational improvements.
