Director of Regulatory Compliance and Quality Assurance

Job Title: Director of Regulatory Compliance and Quality Assurance

Overview:

The Director of Regulatory Compliance and Quality Assurance is responsible for developing, implementing, and overseeing compliance, HIPAA privacy, and quality assurance programs within the healthcare organization. This role ensures compliance with federal, state, and local regulations, as well as internal policies and procedures. The Director will lead initiatives that promote patient safety, quality care, and organizational integrity.

Reports To:

Chief of Staff (in the absence of Chief Clinical Operations Officer)

Department:

Regulatory Compliance and Quality Assurance

Job Description:

• Develop and enforce Standard Operating Procedures (SOPs), conduct staff training on compliance, quality assurance, and HIPAA privacy regulations. Investigate complaints and breaches, ensuring corrective actions align with industry standards
• Serves as the company’s HIPAA Privacy Officer, overseeing HIPAA compliance, privacy and security practices in collaboration with the HIPAA Security Officer
• Conduct regular audits and assessments to identify potential areas of risk and implement corrective action using regulatory documentation tools, as necessary
• Serve as the company’s point person in overseeing the Risk Management Committee charter and efforts managing all cross-functional action items
• Develop and maintain compliance programs in alignment with CMS/HHS/Medicare/Medicaid, commercial payors, OIG, HIPAA, OSHA, and other regulatory requirements (e.g., Stark Law, Anti-Kickback Statute, Telehealth, etc.)
• Monitor regulatory and industry developments, updating internal policies and procedures accordingly
• Collaborate with operations, development, human resources, legal and compliance teams to stay updated on changes in HR compliance requirements, Medicare/CMS. OIG, and any HIPAA regulations to ensure organizational adherence
• Collaborate with various departments to ensure that compliance and quality assurance practices are recognized, prioritized, and integrated into daily operations and workflows
• Oversee the Clinical Quality Assurance program, ensuring adherence to state and federal clinical certification requirements, licensure standards, and billing compliance (e.g., “incident to” physician billing). Ensure compliance with payor regulations, medical necessity, guidelines, and coding for CCM/RPM programs. Collaborate with Clinical Operations to monitor payor performance metrics (HEDIS, HCAHPS, MIPS, NCQA, etc.)
• Act as the primary liaison with regulatory agencies and external auditors, facilitating audits, investigations, and corrective actions, as needed and as directed by Executive Leadership
• Prepare and submit required reports to senior management and the board of directors as requested
• Promote diversity, equity, and inclusion in the workplace
• Other reasonable duties as requested
  
  

Qualifications and Skills Required:

• Required: Minimum of Bachelor’s degree in healthcare administration, nursing, or a related field (master's degree preferred). Alternatively, 5 years regulatory compliance and quality assurance experience in a healthcare setting
• HIPAA Privacy certification from accepted accredited body versus 3 or more years in a HIPAA Privacy Officer role for a healthcare organization
• Certification (preferred): Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or similar credentials
• In-depth understanding of healthcare laws and regulations, including HIPAA, OSHA, Medicare CCM/RPM regulations, and accreditation standards.
• Proven experience in regulatory audits, risk management, and developing compliance programs. Strong technical proficiency with SaaS platforms, CRMs, and Microsoft applications
• Excellent analytical, problem-solving, and decision-making skills
• Proven leadership in managing compliance programs and cross-functional teams using strong communication and interpersonal skills
  
  

Work Location, Shift & Schedule:

This position is fully remote with strict adherence to a Work from Home policy. Occasional travel may be required to offsite locations to participate in regional meetings, client new business opportunities, or industry conferences or tradeshows. Shifox/Alopex full-time employees’ work hours are generally Monday-Friday 8:00am-5:00pm or according to the business hours of your clients’ practices. If working part-time, you and your supervisor will agree on a work schedule.

Remote Position Requirements:

• Stable, high-speed internet for professional calls and video conferencing,
• A quiet and professional work environment suitable for speaking with clients and staff about sensitive information and Protected Health Information (PHI)
  
  

Join Us!

If you have proven leadership in managing compliance programs and cross-functional teams, apply today!

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