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WHAT IS A HEALTHCARE COMPLIANCE OFFICER?

July 16, 2020

As governments and agencies pass more regulations, and the demand for healthcare services grows, healthcare compliance officers are more important than ever. Healthcare entities must comply with an increasingly complex set of laws and regulations. The violation of these regulations can compromise patient safety, breach patient privacy, and incur strict legal and financial penalties. Accordingly, compliance issues have become part of regular practice for healthcare entities.

Practitioners are relying more on healthcare compliance officers (HCOs) to bridge the gap between government regulation and daily operations. HCOs create systems within the practice to ensure compliance with healthcare regulations is a smoothly administered routine.

A healthcare compliance officer is responsible for ensuring that healthcare entities meet laws, regulations, guidelines, and best practices that govern the healthcare industry. HCOs are expected to not only understand healthcare legal issues, but also to work with the hospital or healthcare entity to create practices and procedures that protect the entity, the employees, and the patients.

What Does a Healthcare Compliance Officer Need to Know?

Hiring qualifications for healthcare compliance officers vary but have become increasingly strict as healthcare compliance regulations have grown in complexity. In addition to meeting educational requirements, healthcare compliance officers are expected to earn and maintain industry certifications. These can include CHC, CHPC, CHRC, and CHC-F.

An extensive knowledge of healthcare law is necessary, but HCOs also need to understand the ins and outs of medical office practices. A healthcare compliance officer needs to be familiar with:

  1. Coding
  2. Billing
  3. Reimbursement
  4. Healthcare administration
  5. Clinical activities
  6. Risk management
  7. Investigative activities and protocols
  8. Healthcare agencies and regulatory standards

This background knowledge will provide a basis for the HCO to administer the responsibilities of the position. The daily reality of working with patients, practitioners, and medical staff can be complicated when administering new compliance standards, so it’s vital for healthcare compliance officers to possess excellent leadership and communication skills.

9 Responsibilities of Healthcare Compliance Officers

HCOs are responsible for developing a corporate compliance program and to administer its implementation. Depending on factors such as type of practice and number of employees, this can consist of some or all of the following:

  1. Creating a corporate compliance plan
  2. Identifying potential risks
  3. Ensuring proper creation, maintenance, distribution, and storage of documentation
  4. Training employees on compliance issues
  5. Handling complaints
  6. Holding employees accountable
  7. Safeguarding whistleblowers
  8. Finding mutually beneficial solutions
  9. Creating a culture of compliance

Because organizations rely so heavily on healthcare compliance officers to maintain compliance, HCOs carry a great deal of responsibility. HCOs may use their knowledge, preparation, and leadership skills to implement change within the organizations where they work.

Although healthcare compliance officers may navigate conflict while carrying out job responsibilities, the resulting solutions can be rewarding for both the HCO and the healthcare entity. A well-organized healthcare compliance officer can help the organization not only maintain compliance and mitigate fines and penalties, but also increase levels of organization, communication, trust, and most importantly patient safety.

Healthcare compliance officers are increasingly important for hospitals and practitioners to stay in compliance. Learn more about how Verisys can assist your HCOs in ensuring your providers meet all government and regulatory standards.

Juliette Willard Written by Juliette Willard
Healthcare Communications Specialist
Being creative is my passion! Writer. Painter. Problem Solver. Optimist.
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