How to become a healthcare compliance officer

As complex healthcare regulations are on the rise, so is the need for reliable healthcare compliance professionals.

Healthcare compliance involves proactive tasks to prevent fraud, waste, or abuse within a healthcare organization. An effective compliance program will make sure legal, ethical, and professional standards are being followed and communicated. This is where a healthcare compliance officer comes in, as they demonstrate the expected ethical behavior for others and often are viewed as the public face of the organization.

What is a healthcare compliance officer?

The role of a healthcare compliance officer is essential to an organization as they ensure all employees follow the regulations and laws that govern healthcare information. Because these regulations are constantly changing, the compliance officer’s thorough understanding of the current guidelines makes them key contributors to maintaining an effective compliance program. It is their expertise that makes rigorous compliance within a healthcare organization possible. 

Healthcare compliance officers are often employed by hospitals, doctor’s offices, nursing and residential care facilities, government agencies, and outpatient care centers. Depending on the size of the organization, compliance may be managed by one person, a small team, or a healthcare compliance officer in charge of an entire division.

Some of the different job titles within healthcare compliance:

• Healthcare compliance manager/officer

• Healthcare or hospital regulatory affairs specialist

• Health privacy officer

• Clinical compliance specialist

• Compliance auditor

• Regulatory compliance analyst

• HIPAA compliance specialist

Job duties and responsibilities

A job description for a healthcare compliance officer will typically ask that a potential candidate can:

• Develop, implement, and monitor a compliance program

• Stay up to date on state and federal healthcare legislation

• Conduct internal compliance reviews and audits

• Provide staff education and training on any changes to laws and regulations

• Develop policies and programs for reporting noncompliance issues

• Carry out risk assessments for current facility practices

Steps to become a healthcare compliance officer

Because the role is not typically offered as an entry-level position, this career path comes with some intentional planning and commitment. Here are the steps someone will need to take to become a healthcare compliance officer:

1. Build a strong background in healthcare

2. Take the online CPCO course

3. Study for the CPCO exam

4. Get certified

5. Network in a local chapter

6. Get hired

1. Build a strong background in healthcare

The standard route to becoming a healthcare compliance officer requires earning at least a bachelor’s degree in healthcare compliance, healthcare administration, human resources, or another related field. It is becoming more common for candidates to also have an advanced degree such as a JD or MBA. However, this is not the only route to take.

If someone is already working in the healthcare industry and has at least two years of experience, they can begin working towards getting certified to become a certified professional compliance officer (CPCO)^®. Because of this, it can be a smart move for a medical coder looking to advance their career or anyone working in healthcare who is on the hunt for a new profession.

For those without healthcare work experience, taking the AAPC Essential courses required to enroll in a medical coding training program would be a good place to start. They can begin their career as a medical coder and then after gaining the experience needed, take the next steps to become a certified compliance officer.

2. Take the online CPCO course

Once someone has the Essentials or recommended two years of healthcare experience under their belt, they can enroll in the CPCO course to prepare themselves for passing the CPCO certification exam.

The CPCO course will cover what is needed to effectively develop, implement, and monitor a healthcare compliance program based on government regulatory guidelines — such as internal compliance reviews, audits, risk assessments, and staff training.

Additionally, since it is a self-paced course, there is flexibility for balancing coursework and work schedules.

3. Study for the CPCO exam

The CPCO exam is challenging and requires an overall score of 70% or higher to pass. To be well prepared for exam day, someone should deepen their understanding of what they learned in the training course by thoroughly studying until they know the information well.

Study tools are available not only to increase the chances of passing the exam on the first try but also to feel more confident during testing. With the CPCO certification study guide, someone will be able to utilize twelve chapters that go over what is covered on the exam as well as helpful test-taking techniques. Also, the CPCO online practice exam can be used to get familiar with the format, questions, and time constraints beforehand.

4. Get certified

Once a person successfully passes the CPCO exam, they earn a certificate that proves to employers they have what it takes to be a reliable healthcare compliance officer.

To maintain certification, CPCOs must complete 36 continuing education units (CEUs) every two years.

5. Network in a local chapter

Building connections will be a sure way to open doors to more job opportunities. Aspiring healthcare compliance officers can grow their network by getting involved in their local chapter. This is where they will also learn from the pros, earn free and low-cost CEUs, and make new friends in the same field.

If someone wants to join a local chapter early on, they don’t need to wait until they are certified to get involved.

6. Get hired

At this point in the process, someone is ready to put themselves out there and land a job as a healthcare compliance officer. To make the job-hunting process a lot smoother, take advantage of these AAPC resources:

• Employment forums

• Job search tool

• Mentorship

• Networking

Essential healthcare compliance officer skills

Healthcare compliance officers are leaders that will need to set a strong example of what it means to have an ethical mindset. The skill employers will find most valuable is the ability to lead with integrity.

Other essential skills that will be necessary:

• Strong interpersonal skills

• Ability to mentor, teach and train others

• Intuitive understanding of technology

• High-level knowledge of healthcare ethics

• Clear written and verbal communication skills

• Effective problem-solving capabilities

• A knack for staying organized and paying attention to detail

• Excellent active-listening skills

How much does a CPCO earn?

According to the U.S. Bureau of Labor Statistics, the top five paying states for the healthcare compliance officer position are District of Columbia, New Hampshire, New Jersey, Massachusetts, and Connecticut. But overall, the national average salary for CPCOs is $80,550 per year.

To find a more specific estimate based on certain factors such as location, years of experience, and certification(s), use the AAPC salary calculator.

Last Reviewed on Jan. 16, 2023