Director, Corporate Compliance

Job Summary

JOB SUMMARY
Work to ensure the Company’s compliance with contractual requirements and federal, state, and local government regulations pertaining to the Company’s health care supplier business (with a focus on durable medical equipment and supplies), including monitoring operational functions, conducting routine audits, and serving as a resource for addressing questions from the business. Research and keep current on federal, state, and local government regulatory and compliance matters impacting a highly regulated health care business. Prepare and complete health care regulatory and compliance policies and guidance documents. Reports to Chief Compliance Officer.

Job Description

MAJOR RESPONSIBILITIES

Along with Chief Compliance Officer, provide day to day guidance to business on strategies and initiatives.

Conduct and oversee regular and routine auditing and monitoring of functions pertaining to the compliant operation of a durable medical equipment supply business, with a focus on activities that are deemed to be higher risk in accordance with federal, state and local laws and regulations.

Conduct regular and routine auditing and monitoring of claims submission, billing and payment functions for compliance with applicable payer rules and Medicare/Medicaid requirements.

Prepare and provide reports and analysis to the Compliance Officer and Company executive management detailing audit results, rule violations, the status of investigations, corrective or preventive actions underway and any recommendations for compliance program improvements. Report matters involving compliance with law or regulation to the Legal Department.

Oversee updates, revisions and releases of company policy and guidance documentation and ensure current revisions are available for employees to access and review and consistent with risk areas identified through auditing and monitoring. Assist with roll out and implementation of company polices and guidelines based on identified risk areas and changes in policy or regulation.

Research and track federal, state, and local government regulatory and compliance matters impacting a highly regulated health care business to ensure that Company policies and guidance are current and that ongoing audits are consistent with legal and regulatory changes.

Keep abreast of industry standards and outlooks related to corporate responsibility and compliance practices, as well as regulatory news that could affect the company's business activities regionally, nationally or internationally.

Update policies and guidance documents as needed to address changes to laws, regulations, or company rules and guidelines.

Manage and control records relating to audit results, reports of noncompliance, and investigation requests and results. Evaluate records and the compliance program's documented policies and procedures.

Plan and perform process and documentation audits to ensure written policies meet company needs and regulatory requirements and validate employee awareness of the company's rules and expectations.

Facilitate communications to, and training for, new employees and for existing employees when new rules are established, revisions are made to existing policies and as periodic reminders of employee responsibilities to following compliant work practices.

Serve as a resource on compliance matters for business colleagues.

Assist with the development and roll-out of training on the company’s compliance policies and guidance.

May train new employees during orientation and the entire employee population as needed to address changes to company requirements and expectations. - Management responsibilities include:

Typically manages through multiple Managers

Provide leadership and management to one or more major departments of an operating unit or to a department that has system-wide accountability - Strategic, tactical and operational planning (12 + months) for the function or department

Direct budgetary responsibility for one or more departments, functions or major projects/programs

Interpret and execute policies for departments/projects; develop, recommend and implement new policies or modifications to existing policies

Hiring staff, recommending pay increases, performing performance reviews, training and development of staff, estimating personnel needs, assigning work, meeting completion dates, interpreting and ensuring consistent application of organizational policies

MINIMUM QUALIFICATIONS

Education

Bachelor’s degree. Graduate degree preferred.

Certification / Licensure

None required.

Work Experience

At least 7-10 years compliance, regulatory or auditing experience.

Familiarity with coding and reimbursement.