Director, Compliance (Healthcare)

Job Description
SUMMARY OF JOB DUTIES:
A Corporate Compliance Officer plays a critical role in ensuring that a company adheres to all legal standards, regulatory requirements, and in-house policies and procedures. Their primary responsibilities involve developing and overseeing the implementation of compliance programs, policies, and procedures to guarantee that the organization is operating within the boundaries of relevant laws and regulations.
ESSENTIAL JOB FUNCTIONS:

• Developing Compliance Programs: Designing and implementing comprehensive compliance programs to prevent, detect, and address violations of legal guidelines and internal policies.
• Policy Implementation: Ensuring that the company's policies and procedures comply with relevant laws and regulations, and overseeing their communication and implementation across the organization.
• Privacy: Monitor data management procedures and systems to ensure the security and confidentiality of sensitive information. Conduct privacy impact assessments to identify and address potential privacy risks within the organization.
• Risk Assessment and Monitoring: Identifying potential areas of compliance vulnerability and risk within the organization and developing strategies to minimize these risks.
• Training and Education: Conducting training programs for employees to promote understanding and awareness of compliance issues, laws, and regulations.
• Internal Investigations: Leading or coordinating internal investigations into compliance issues, including allegations of wrongdoing or policy violations.
• Reporting and Documentation: Compiling and submitting regular reports to senior management and the Board of Directors and relevant regulatory bodies, detailing the status of compliance within the organization.
• Auditing and Evaluation: Conducting regular audits and assessments to ensure that the company is in line with legal and regulatory standards.
• Fraud, Waste, and Abuse: Develop plan to identify and prevent fraud, waste, and abuse and incorporate into the risk assessment
• Stakeholder Communication: Serving as a point of contact for employees seeking guidance on compliance-related matters and fostering open communication between departments.
• Stay Abreast of Regulatory Changes: Keeping up-to-date with changes in regulations, laws, and industry standards, and supporting organizational leadership to interpret and implement necessary changes within the organization to maintain compliance.
• Ethics Oversight: Promoting an ethical and compliant culture within the organization by advocating for ethical behavior and integrity in all business practices.
• Risk Management: Collaborating with other departments, such as legal, finance, and human resources, to ensure comprehensive risk management across the organization.

External Engagement: Representing the organization in dealings with regulatory agencies, auditors, and other external stakeholders as required.
Requirements
MINIMUM REQUIREMENTS

• Requires a Bachelor's degree in a related area or equivalent work experience
• Advanced degree in health care administration, health care policy, clinical discipline, or related field strongly preferred.
• 4 to 7 years of relevant experience in healthcare
• Experience interacting with regulatory authorities
• CCEP or CHPC preferred
• Knowledge of federal and state laws and industry requirements affecting Complete Health strongly preferred, including but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA); Health Information Technology for Economic and Clinical Health (HITECH) Act; the Anti-Kickback Statute, Physician Self-Referral Law (Stark); the False Claims Act; and the Patient Safety and Quality Improvement Act.