Director of Healthcare Compliance

Why Join Us:

• Exemplary healthcare group with over 50,000 employees and operating revenue exceeding $15 billion
• Multiple awards for Best Workplaces, Service Providers and Innovators
• Opportunity to work directly with executive compliance team in strategy and development of the program
• Culture based on collaboration, empowerment and a focus on the customer

Responsibilities:

• Reporting to the VP of Corporate Ethics and Compliance, managing a team of ten, you will be responsible for planning, developing, and enforcing compliance programs, which may include varied compliance functions and programs such as provider regulatory compliance, coding compliance, compliance hotline services, conflict of interests, education, and other compliance activities
• Directs billing, regulatory and provider coding compliance for assigned area of responsibility
• Recommends and implements strategic and operational plans and priorities for compliance programs aligned to overall business objectives
• Directs the identification and evaluation of emerging compliance risks by utilizing regulatory guidance, data analytics, and other compliance best practices
• Leads the resolution of compliance issues for physicians, advanced practice providers, practice administrators, and other physician practice staff
• Plans and directs compliance audits to assess compliance and communicates audit findings and
• recommendations
• Directs regulatory research and provides written guidance on regulatory changes and interpretive guidance on billing or regulatory concerns
• Develops and presents provider coding compliance progress and summary reports or presentations to physicians and executive leadership
• Promotes consistency in the provider coding audit and education processes for all employed physicians and advanced practice providers
• Leads a multidisciplinary team to evaluate regulatory requests, audits, and denials and recommend necessary process changes
• Tracks the resolution of corrective actions agreed to by senior leadership in response to compliance audits or investigations and provides summary reports of activity
• Assist the Office of Corporate Ethics and Compliance in identifying, evaluating and resolving provider-related potential conflict of interests; identifies potential areas of compliance vulnerability and risk and develops/implements corrective action plans for resolution of problematic issues

Requirements:

• Education: Bachelor’s degree
• Desirable: Healthcare Compliance Certification (e.g. CHC) and Coding Certification (e.g. CPC)
• Significant experience as a compliance professional in healthcare delivery – including demonstrable advanced knowledge of billing and coding process and regulation
• Proven people-management skills