What Does a Health Care Compliance Officer Do?

What does a health care compliance officer do? Modern health care organizations are highly regulated, with legal and ethical obligations to patients, professional standards bodies, and government agencies.¹ They must also ensure they comply with the reporting and billing practices of public and private insurance plans. And they are massive, complex organizations that have a general interest in ensuring they minimize waste and eliminate any potentially fraudulent activity.¹

Broadly speaking, a health care compliance officer plays a significant role in managing all of those obligations and ambitions within the organization. Compliance with legal and ethical standards is essential for safeguarding patient safety and protecting the organization from legal challenges, and it’s the health care compliance officer’s job to keep the organization aligned with those critical standards.

This post looks more closely at the typical health care compliance officer job description, breaking down key responsibilities and describing the skills and qualities that contribute to success in this critical role in modern health care.

What Is a Health Care Compliance Officer?

In the context of corporate governance, compliance means following the rules.² Compliance is an important function in most businesses, since most businesses operate within some set of laws and regulations, but it becomes particularly important in fields that are highly regulated, such as banking or health care.

At its core, the purpose of a health care compliance officer is “to mitigate risk,” says the American Institute of Healthcare Compliance.³ To fulfill that purpose, health care compliance officers oversee internal audits of an organization’s practices, focusing on how they match up with legal and ethical requirements. They are also responsible for training employees and developing policies to ensure the organization is fully equipped to function in a compliant fashion.

Key Responsibilities

The key responsibilities of a health care compliance officer can be broken down into five critical functions:³

• Developing and implementing compliance programs: A compliance officer is expected to establish how an organization will achieve compliance through clear, actionable strategy and programs
• Monitoring adherence to federal and state regulations: The health care compliance officer must keep up to date on federal and state regulations, ensuring organizations adapt as necessary when required by adjustments to regulatory standards
• Conducting audits and risk assessments: Audits focus on existing processes, such as health care billing, and examine them for evidence of incorrect or improper activity; risk assessments evaluate how the organization might be exposed to certain risks of breaching its legal and ethical obligations, thereby informing policies to mitigate those risks
• Training employed and contracted staff on compliance policies: An organization cannot be compliant if it doesn’t know what to do. Health care compliance officers make sure employees and contractors have adequate training to be aware of their role in maintaining compliance
• Investigating and reporting violations: Complaints and breaches of compliance must be investigated and followed through to a satisfactory resolution

Skills and Qualities Needed

The pathway to qualifying as a health care compliance officer includes sitting the exam for the Certified in Healthcare Compliance (CHC) designation from the Compliance Certification Board (CCB).⁴ To be eligible for the exam, however, you must first acquire a CCB-mandated level of relevant experience and education.⁵ A standalone graduate certificate or specialized master’s degree from a suitably accredited program is often the most efficient way to satisfy specific CCB requirements and ensure you have the general skills and knowledge necessary to excel in health care compliance.

When you graduate from a CCB-accredited program such as the Online Master of Studies in Law with a Health Care Compliance specialization from the University of Pittsburgh School of Law, or Pitt Law’s Online Health Care Compliance Certificate program, you’re not only acquiring a credential that satisfies eligibility requirements for the CHC exam—you’re ensuring you have a solid foundation for your career.

Our career-focused curriculum develops critical skills and qualities, including:

• Attention to detail and analytical thinking: Health care compliance officers need to be able to analyze long, complex regulatory documents, breaking down processes and regulations to understand what compliance means in practical terms
• Communication and leadership skills: A compliance officer is tasked with finding ways to ensure organizations remain compliant by developing and communicating policies and training programs, as well as demonstrating the necessary leadership to encourage necessary behavioral change or adaptation
• Knowledge of specific healthcare laws: From the Health Insurance Portability and Accountability Act (HIPAA) to the False Claims Act (FCA), and a host of other federal, state, and specialty laws and guidelines, compliance officers need specific knowledge of the laws and rules that govern health care and related activities

Work Environment and Career Settings

Health care compliance officers can find work in a variety of settings, from hospitals and clinics to insurance companies and government agencies. Both the regulated and the regulators require compliance expertise.

As a health care compliance officer, you can expect a high degree of collaboration within your organization. The role overlaps with legal, HR, and administrative responsibilities, meaning compliance officers are often working closely alongside colleagues within those functions.

Advance Your Career in Health Care Compliance with Pitt Law

Compliance is an essential role in modern health care. The industry is highly regulated to protect patients and employees. Navigating the regulations is a highly complex task that is best assigned to specialist professionals, who have the training necessary to design and implement the required policies.

If you’re considering a career in health care compliance, you’ll generally need a combination of formal education and practical experience to be eligible for the CHC exam. A bachelor’s degree—ideally in a related field, such as biology or public health—is a good start. If you are not already working in the health care industry, you may want to look for internships at your local hospital or clinic to develop an understanding of how health care organizations function. From there, look for a CCB-accredited graduate program that specializes in health care compliance and prepares you for CHC certification.

Pitt Law’s online MSL with a specialization in Health Care and online Health Care Certificate are both CCB-accredited programs, allowing graduates to meet both the work experience and educational requirements to take the CHC exam. Our flexible, career-focused curriculum is ideal for working professionals. Benefit from the expert teaching of Pitt Law’s highly respected faculty and the reputation and alumni network of one of the most respected law schools in the U.S.

Review course information, admissions requirements, and application details online. When you’re ready to discuss what Pitt Law can do to progress your career in health care compliance, schedule a call with one of our admissions outreach advisors.