Over the past three decades in my career as a compliance adviser and advocate for healthcare organizations, I have been asked the same question countless times: “What is a compliance officer?” Even within a single organization, if you pose this question to 12 people, you will likely receive at least 13 different answers. I have repeatedly faced this conundrum in various contexts, such as presenting to governing boards and senior leaders, assisting organizations in defining the roles of legal and compliance professionals, evaluating compliance programs, and mentoring in the field of compliance. This persistent ambiguity regarding the role of a compliance officer has hindered the growth of the profession for far too long. It is time to address the issue from a fresh perspective, which I aim to do here.
Introduction: The diverse paths to becoming a healthcare compliance officer
The healthcare compliance field stands out for its openness to individuals from a variety of backgrounds. Unlike other professions where a specific degree, license, or experience might be a prerequisite, this field is characterized by its extraordinary receptivity to people with a wide array of experiences. This diversity strengthens both the profession and the organizations that benefit from the services of compliance officers. It encompasses professionals with backgrounds in clinical disciplines, law, coding, auditing, finance, medical records, quality, and other healthcare-related fields. This is likely because the multifaceted nature of compliance in healthcare demands expertise in such a wide array of areas, including clinical practices, laws and regulations, and privacy and security, among many others.
The sheer variety of professional backgrounds from which compliance officers may emerge has made it difficult to pinpoint a universal definition of the role. This profession doesn’t fit into any mold. The role can be influenced by broad proficiencies, which is a strength rather than a drawback. Different perspectives contribute to more comprehensive and effective compliance programs. Instead of focusing on background and experience, it might be more productive to consider the roles a successful compliance officer must fulfill. Regardless of the journey that led them to the position, a healthcare compliance officer must be adept in various roles crucial to the compliance domain.
In this article, we will explore the distinct roles that a healthcare compliance officer must assume—independent of their professional pedigree. Regardless of your experience in auditing, law, patient care, revenue cycle management, or other areas, these roles form the foundation of effective compliance in the healthcare sector. The strategies and tools discussed here can be customized to meet the unique needs of each organization and align with the specific skills and knowledge of the compliance officer. With that said, let us delve into the multifaceted roles that a healthcare compliance officer must play to help ensure the integrity and success of their organization.