Director of Compliance

Position Purpose

This position directs the Compliance Program and its Department members toward the achievement and maintenance of compliance with Federal and State compliance and regulatory requirements by providing leadership, mentoring and goal achievement. This position provides administrative oversight, direction and support of the Compliance Program. The position is responsible for identifying and assessing areas of compliance risk for the organization and ensuring that the elements of a compliance program are in place and operating effectively on a day-to-day basis.

Nature and Scope

This position, in conjunction with the Chief Compliance Officer, will maintain an effective Compliance Program.

This position will coordinate the Compliance Department Staff and other resources to ensure the ongoing effectiveness of the Compliance Program.

Specifically, this position will assist the Chief Compliance Officer by effectively providing for the:

• Demonstrates strong knowledge of healthcare compliance laws and regulations (e.g., HIPAA, EMTALA, Medicare, Medicaid, Anti-Kickback, Fraud and Abuse laws, False Claims Act, Employee Retirement Income Security Act, Mental Health Parity and Addiction Equity Act, Affordable Care Act) in order to coordinate an effective Compliance Program.

• Directs new compliance programs and activities.

• Performance of annual and ongoing risk assessments.

• Effective management of all system policies and procedures.

• Exclusion Checking Process.

• Conflict of Interest Program.

• Develops goals and objectives for the Department in coordination with the Chief Compliance Officer.

• Oversees and ensures that the Department operations that are necessary for an effective Compliance Program including, but not limited to are in place and functioning: program structure, policies and procedures, education, auditing and monitoring, maintenance of open communication lines, prompt responses to investigations, enforcement/discipline, annual and/or periodic Risk Assessments.

• Responding to issues raised through confidential and other reporting mechanisms in a retaliation-free manner.

• Ensure that Disciplinary Actions are taken in a Just Culture environment.

• Track all issues referred to the Compliance Department.

• Develop productive working relationships with all levels of management.

• Demonstrates strong management and leadership skills.

• Performs and coordinates quality improvement activates for the Compliance Department.

• Demonstrates high levels of communication from all level of internal and external audiences.

• May perform annual and ongoing risk assessments, including the Revenue Cycle risk (documentation, coding and billing of professional and facility care).

• May draft relevant detail of the Annual Report to the Board through its Audit and Compliance Board Committee.

• May investigate or direct the investigation of all billing and coding investigations.

• Establishes, as required, active relationships with Regulators or third parties in conducting oversight of fraud, waste and abuse program management and health plan compliance.

• Reviewing and assessing potential fraudulent activity and developing fraud detection tools in the health plan space.

• Oversees and ensures health plan delegated entity compliance as appropriate with required laws, rules, regulations, and accreditation organization standards and health plan requirements, as well as, operational performance requirements and enforcement of the written delegation agreement.

Perform other duties as assigned by the Chief Compliance Officer.

Incumbent must have proven track record of leadership and must be successful in a team environment. Dynamic and articulate with excellent communication skills including positive and effective presentation skills.

This position does not provide patient care.

Disclaimer

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

Requirements - Required and/or Preferred