The Senior Compliance Director oversees the Radnet Compliance department’s billing and coding compliance auditing activities and assures the timely performance and consistent collection and analysis of compliance audit data and documentation. The Director identifies areas to audit, develops tools to perform audits and works with the Coding and Auditing Manager and Coding Auditor Specialists to deliver results to the Corporate Compliance Committee. The Director reports directly to and works closely with the Senior Vice President, Compliance and Regulatory Affairs (SVPCRA).

The Director will develop audit policy, procedures and related audit reports, standards, and tools. They will also maintain awareness of federal and state payer integrity program contractor activities, research federal and state regulations and guidelines for impacted related matters and review/draft policy and procedures, providing federal and state regulatory guidance and compiling subject matter research. The Senior Compliance Director will work closely with and support the Manager, Compliance Auditing & Projects and the Compliance department’s compliance auditing.

Responsibilities:

• Oversee compliance department auditing and monitoring functions.
• Create, integrate and implement new protocols, guidelines, policies and procedures and audit tools
• Oversee and manage the Compliance Manager and auditing team.
• Ensure timely performance and consistency of the collection and analysis of data and documentation.
• Prepare documents of compliance audit findings and recommendations for Quarterly Compliance Committee meetings
• Communicate findings and recommendations for corrective action to the Corporate Compliance Committee.
• Manage the corrective action process encourage timely follow up across departments.
• Support the Senior Vice President of Compliance and Regulatory Affairs (SVPCRA) with compliance matters.
• Maintain collaborative relationship with Revenue Cycle Operations leadership on compliance and reimbursement matters.
• Research and provide answers to questions asked about regulation, regulators and impacted business practices.
• Review and assist with drafting of policies and procedures on behalf of Compliance.
• Assist in the development and implementation of other components of the compliance program.
• Update Compliance and compliance related training and awareness- raising programs and materials.
• Maintains awareness of federal and state payer Integrity Program contractor activities.
• Assist with responding to government investigations, probes, audits and queries in coordination with General Counsel and associated leadership.

PLEASE NOTE: This is not an exhaustive list of all duties, responsibilities and requirements of the position described above. Other functions may be assigned and management retains the right to add or change duties at any time.

Minimum Qualifications, Education and Experience:

• A four-year degree in business administration or health care administration or six or more years of experience in the radiology service industry and management experience.
• Must have current and maintain certification as one of one of the following Radiology Certified Coder (RCC), Certified Professional Coder (PCP), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician (CCS-P).
• Knowledge of state and federal health regulations.
• Understands how external forces in the healthcare industry affects operations and revenues.
• Ability to exercise a high degree of initiative, judgment, discretion and decision-making to achieve department and organizational objectives.
• Ability to communicate effectively through verbal and written communication.
• Ability to share information effectively and provide appropriate direction to team members.
• Ability to delegate responsibility and authority to team members.
• Ability to maintain proactive relationship with referring physicians.
• Respond to compliance and training attestations requested by third party payors.
• Knowledge of developing budgets, general computer skills, and Microsoft Office knowledge.
• Demonstrates leadership skills in interactions with peers in senior management.
• Maintains a “team” mentality within Compliance and Quality Assurance teams and as a member of senior management.
• Knowledge and understanding of CMS Regulatory, MAC and Medicaid/Medical guidelines as well as knowledge of payment schemes for out- patient encounters.
• Knowledge and ability to follow standard practices in coding and reimbursement with knowledge of CPT, ICD, and HCPCS codes.