Regional Director Compliance & Denial Mgmt

Regional Director of Compliance & Denials Management

Position Summary:

The Regional Director of Compliance & Denials Management provides regulatory oversight and revenue protection across assigned hospice markets. This role ensures adherence to all federal, state, and accrediting body requirements while leading proactive denial prevention, audit response, and reimbursement risk mitigation strategies.

This position operates at the intersection of Compliance, Operations, Quality & Education, and Revenue Cycle to protect licensure, certification, reimbursement, and regulatory standing. The role supports a state of continuous survey readiness and drives reduction in denial risk through structured monitoring and trending .

Required Experience:

• Bachelor’s degree required; Master’s degree preferred
• Minimum 5 years of hospice regulatory and compliance experience
• Demonstrated experience with Medicare hospice reimbursement and documentation standards
• Experience managing ADRs, UPICs, TPEs, SMRCs, and payer appeals
• Strong analytical and reporting skills
• Ability to influence operational leaders without direct authority
• Multi-state or multi-site experience preferred

Preferred Qualifications:

• Experience leading survey readiness initiatives
• Experience overseeing internal audit programs
• Prior collaboration with Quality & Education teams
• Experience building denial tracking dashboards
• Certified in Healthcare Compliance (CHC) or similar certification preferred

Responsibility for Regional Director of Compliance & Denials Management

• Ensure compliance with CMS Conditions of Participation (CoPs) and state hospice regulations
• Oversee survey readiness and coordinate regulatory survey responses
• Lead regional denial prevention strategy and trend denial data
• Monitor ADRs, UPICs, TPEs, SMRC audits, Medicare Advantage and commercial denials
• Analyze root causes of denials and partner with Operations to reduce recurring issues
• Oversee timely appeal submissions and track overturn rates
• Conduct comprehensive and focused internal audits
• Monitor eligibility documentation, IDG compliance, and face-to-face requirements
• Lead development and monitoring of Plans of Correction (POCs)
• Maintain compliance dashboards and provide reporting to Executive Leadership
• Escalate unresolved compliance risks as appropriate
• Partner with Revenue Cycle, Clinical Operations, HR, and Executive Leadership

Skills for Success:

• Regulatory expertise and hospice clinical knowledge
• Strong analytical and financial acumen
• Executive presence and professional communication
• Operational discipline and structured follow-through
• Ability to balance regulatory oversight with collaborative leadership
• Ability to balance standardization with flexibility

General Working Conditions:

This position entails sitting for long periods of time. While performing the duties of this job, the employee is required to communicate effectively with others, sit, stand, walk and use hands to handle keyboard, telephone, paper, files, and other equipment and objects. The employee is occasionally required to reach with hands and arms. This position requires the ability to review detailed documents and read computer screens. The employee will occasionally lift and/or move up to 25 pounds. The work environment requires appropriate interaction with others. The noise level in the work environment is moderate. Ability to wear Personal Protective Equipment (PPE).

This classification description is intended to indicate the general kinds of tasks and levels of work difficulty that are required of positions given this title and should not be construed as declaring what the specific duties and responsibilities of any particular position shall be. It is not intended to limit or in any way modify the right of any supervisor to assign, direct and control the work of the employees under her/his supervision. The use of a particular expression or illustration describing duties shall not exclude other duties not mentioned that are of a similar kind or level of difficulty.

Equal Opportunity Employer

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