Senior Director, Compliance

Overview:  The Senior Director, Compliance is responsible for the execution and management of ComplexCare Solutions’ compliance, privacy and delegation oversight functions.  This role will also provide advice on a range of healthcare compliance matters, including regulatory, third-party risk, practitioner credentialing and compliance audit requirements. The incumbent will further support compliance requirements and risk-based strategies to advance product development, business expansion and growth initiatives. 

Duties and Responsibilities:

• Manage the day-to-day operations of ComplexCare Solutions’ Corporate Compliance and Privacy program to include regulatory compliance topics, customer audit responses, management of attestations and complaint management;
• Direct and lead the delegation oversight function which includes ensuring that delegates are meeting contractual obligations and compliance with Centers for Medicare and Medicaid Services (CMS) regulations, National Committee for Quality Assurance (NCQA) standards and other relevant policy;
• Oversee the coordination and implementation of client corrective action plans;
• Investigate and manage compliance and privacy concerns raised through ComplexCare Solutions’ Compliance Hotline and other reporting channels, and implement resolution strategies;

• Manage periodic privacy and compliance risk assessments, including mitigation and remediation efforts;

• Lead the enterprise-wide provider credentialing functioning;

• Conduct annual reviews of compliance policies, the Code of Conduct and implement necessary revisions;

• Collect and analyze data for compliance data requests and recurring dashboards and scorecards.

• Complete customer and vendor questionnaires regarding the Company’s policies
• Lead ComplexCare Solutions’ compliance training strategy and develop/implement related materials;
• Represent Complex Care Solutions on client calls and other audit, delegation and credentialing meetings;
• Maintain compliance with Complex Care Solutions’ policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within Complex Care Solutions’ Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
• Fulfill those responsibilities and/or duties that may be reasonably provided by Complex Care Solutions for the purpose of achieving operational and financial success of the Company; and
• Other duties as assigned.

Job Requirements:

• Minimum of nine (9) years of prior compliance experience which may include healthcare regulatory, risk assessment and audit experience;
• Minimum of five (5) years of prior experience managing teams and direct reports;
• Working knowledge of key laws and regulations that apply to provider compliance, including Anti-Kickback Statute and Medicare and Medicaid program requirements;
• Prior work experience in the healthcare industry is preferred;
• Knowledge and direct experience with CMS compliance program requirements;
• Knowledge of state and federal regulatory bodies such as CMS and NCQA;
• Compliance experience in risk adjustment is a plus;
• Must excel in fast-paced environment with a broad set of diverse stakeholders;
• Highly professional demeanor, communication style and approach, analytical and critical decision-making, investigational skills;
• Effective verbal and written communication skills and interpersonal skills with the ability to effectively listen and communicate to varied levels; and
• Strong problem solving, risk analysis and project management skills and the ability to work with minimal supervision.

Education:

• Bachelor’s Degree or equivalent work experience required; and
• Compliance related certification preferred.

Physical Demands and Work Environment:

• Sedentary work (i.e., sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Up to approximately 10% travel may be required.