Compliance Director

Compliance Director is responsible for managing activities related to developing, implementing, maintaining, and adhering to policies and procedures in compliance with federal, state, and local healthcare laws and regulations. Compliance Director is responsible for providing guidance to senior leadership team and clinicians on all compliance-related matters, working with outside legal counsels when appropriate to determine risks and action plans and implementing policies and procedures to ensure consistency across the practices.

Major Duties and Responsibilities:

• Oversees and monitors the organization’s compliance program.
• Identifies potential areas of compliance vulnerability and risk by conducting risk analysis; develops/implements corrective action plans for resolution of problematic issues and provides general guidance on how to avoid or deal with similar situations in the future.
• Reports on a regular basis to the organization’s compliance committee on the activities of the compliance program.
• Revises the compliance program, and at least annually, in response to changes in regulations and in accordance with the needs of the organization.
• Develops and coordinates an educational and training program for employees on the elements of the compliance program and ensures employees are knowledgeable of relevant federal and state regulations.
• Works with human resources to ensure all employees and contractors have been screened and checked against sanction and exclusion lists.
• Serve as a subject matter expert on Billing and Coding compliance and advise company accordingly.
• Leads an internal compliance review, monitoring activities, payor audits, etc.
• Facilitates the internal chart review program.
• Investigates and acts on compliance matters including coordinating corrective actions.
• Develops policies and programs that encourage employees to report suspected compliance issues.
• Maintains current knowledge of healthcare laws and regulations, keeping abreast of changes as they take place.
• Other duties as assigned.

EDUCATION AND EXPERIENCE

• University degree in healthcare or legal.
• Minimum of five years of experience in compliance function with focus on healthcare industry.
• Active Compliance Certificate, i.e. CHC, CPCO, etc.
• Experience in developing, implementing and executing Compliance programs in healthcare.
• Experience in the design and implementation of compliance metrics.

SPECIFIC SKILLS

• Strong communication and presentation skills (verbal and written), including board level presentations.
• Must possess very strong business judgment and the ability to understand and respond to business issues and needs.
• Strong commitment to high standards of integrity, professionalism, loyalty, honesty, respect, and business ethics is required.
• Must be able to work independently, and handle both small and large matters with equal effectiveness and enthusiasm.
• Must be able to thrive in a fast-paced environment with ever-changing business objectives, be willing to adapt to change, as well as being capable of driving change.