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Director of Compliance

Come work where we specialize in you! We have nearly 2,000 reasons for you to consider a career with Prevea Health-they're our employees. We're an organization that values kindness, responsibility, inclusivity, wellness and inspiration. At Prevea, we provide continuous education, training and support so every member of the team contributes to our success. Together we are the best place to get care and the best place to give care.
Job Summary
The Director of Compliance is responsible for the oversight of Prevea's compliance program which includes planning, coordinating, and monitoring all activities in relation to the organization's Corporate Compliance Program. This role is responsible for the development and implementation of corporate policies across the organization. The role serves as Compliance Officer and is responsible for developing a proactive approach to compliance in line with the focus of HHS Office of Inspector General and other government enforcement agencies which includes researching, analyzing, and providing oversight of the response to regulatory related inquiries. This position oversees the compliance program through analysis of existing policies and procedures, performing risk assessments, developing work-plans, overseeing compliance audits and performing regulatory reviews. The Director of Compliance serves as a resource for the interpretation and analyses of rules and regulations related to compliance activities. Working with multi-disciplinary teams, performs in-depth reviews of organizational processes to ensure legislative and regulatory compliance.
What you will do

• Compliance Program Oversight- Lead and oversee the organization's Corporate Compliance Program, ensuring alignment with federal and state regulatory expectations and industry best practices.

*Establish an annual compliance audit plan aligned with the OIG Work Plan that identifies areas of concern and/or risk and develop annual audit plan based on that Work Plan.

* Direct investigation processes into alleged violations of rules, regulations, policies, procedures and Code of Conduct issues.

* Ensure proper reporting of violations or potential violations to enforcement agencies as appropriate or required.

* Work in concert with legal department to serve as a resource in the event of a government or other agency investigation.

* Under the direction of the legal department, work with outside legal counsel and consult when needed to resolve/research difficult compliance issues.

* Ensure leadership team is appropriately involved concerning significant activities, including the status of investigations, compliance audits or other issues that may require corrective action.

*Administer annual conflict of interest program and follow up on any potential concerns.

• Compliance Auditing, Monitoring & Corrective Action Leadership- Direct internal monitoring and audit activities to assess and improve compliance performance.

* Liaison with third party and government payors on compliance and quality issues, ensuring a timely response and implementation of corrective or improvement actions as required.

* Develop, implement, and monitor correction action plans in alignment with the annual compliance audit plan. Partner with the Manager of Revenue Integrity and executive leadership to oversee internal and external auditing and monitoring activities to assess compliance with applicable laws and regulations.

* Provide strategic direction regarding medical record documentation audits to ensure that documentation supports the service billed is in accordance with the appropriate billing and coding compliance standards.

* Establish performance expectations and improvement plans for compliance where deficits are identified through internal or regulatory audits.

• Compliance Committee & Cross-Functional Alignment - Provide enterprise leadership for compliance governance and interdisciplinary coordination

* Chair the Compliance Committee and provide updates to the executive leaders and the board as needed.

* Coordinate with Human Resources and Finance leadership to ensure policies and procedures related to employee relations practices, business office operations and provider billing activities comply with applicable federal and state laws, regulations, and organizational policies.

• Regulatory Policy & Education Oversight- Ensure organizational policies, training, and operational practices remain compliant with applicable regulatory and contractual requirements.

* Oversee the development, review, updating and maintenance of clinic policies and practices.

* Direct Prevea's process for policy dissemination and other activities as stated in the Compliance Program.

* Develop documents and assist in implementing policies and procedures to ensure compliance with state, federal and third-party requirements and to minimize risk.

*Serve as a subject matter resource for forms review and development across all departments.

*Proactively develop and offer education to leaders and staff, including the oversight of Prevea's annual learning program.

Education Qualifications

• Bachelor's Degree In any field Required
• Doctorate Juris Doctor (J.D.) Preferred

Experience Qualifications

• 5-7 years Compliance experience in healthcare setting required Required
• 3-5 years Leadership experience Required

Skills and Abilities

• Knowledge of ICD-9 and CPT coding
• Capable of leading strategic process change.
• Excellent interpersonal skills and behaviors
• Ability to form professional relationships with all stakeholders.
• Ability to prioritize work and meet changing demands
• Ability to handle and process confidential information.
• Skilled in problem-solving techniques.
• Fosters teamwork through effective written and verbal communication
• Ability to manage teams and conflict effectively.
• Ability to understand and manage complex budgets
• Effective project management and organization skills.
• Knowledge of appropriate regulatory compliance topics

Licenses and Certifications

• Certified Professional in Health Care Compliance Upon Hire Preferred

Physical Demands

• Sit - Constantly
• Stand - Occasionally
• Walk - Occasionally
• Drive - Occasionally
• Climb (Stairs/Ladders) - Rarely
• Bend (Neck) - Frequently
• Squat - Rarely
• Twist/Turn (Neck) - Frequently
• Twist/Turn(Waist) - Rarely
• Lift/Carry 0-10 lbs. - Occasionally
• Lift/Carry 11-25 lbs. - Rarely
• Lift/Carry 26-35 lbs. - Rarely
• Lift/Carry 36-50 lbs. - Rarely
• Push/Pull up to 10 lbs. - Rarely
• Push/Pull 11-25 lbs. - Rarely
• Push/Pull 26-35 lbs. - Rarely
• Reach (Above shoulder level) - Rarely
• Reach (Below shoulder level) - Occasionally
• Simple Grasping (Hands/Arms) - Constantly
• Fine Manipulation (Hands/Arms) - Constantly
• Gross Manipulation (Hands/Arms) - Occasionally

Travel Requirements

• 5%

Hearing Requirements

• Hears Whispers < 3 feet - Constantly
• Hears Whispers 3-8 feet - Constantly

Vision Requirements

• Color Discrimination - Constantly
• Near Vision (Correctable to Jaeger 2 or 20/30 binocular) - Constantly
• Distance Vision (Correctable to Snellen chart 20/30 binocular) - Constantly

Prevea is an Equal Employment Opportunity/Affirmative Action employer. In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United State and to complete the required employment eligibility document form upon hire. Prevea participates in E-verify. To learn more about E-Verify, including your rights and responsibilities, please visit www.dhs.gov/E-Verify