Overview
Director, Compliance Jobs in United States at Confidential Jobs
Title: Director, Compliance
Company: Confidential Jobs
Location: United States
The Director, Compliance Investigations will report to the Chief Compliance Officer and is a leadership position requiring internal and external presence reflecting high integrity and clear accountability for the management of the company’s Fraud, Waste, and Abuse activities and contributor to Payment Integrity program.
Essential Functions:
- Oversee the organization’s Fraud, Waste, and Abuse program and ensure timely response, investigation, root cause analysis and corrective actions to issues identified or reported, including documenting the work performed and actions taken
- Lead the development and implementation of proactive analytical strategies to detect and mitigate Fraud, Waste, and Abuse
- Manage the development and implementation of prospective and retrospective FWA avoidance, detection, investigation, and recovery activities with a focus on the continual financial impact generated by investigation and analysis activities
- Communicate all Fraud, Waste, and Abuse activities and results internally to senior leadership and other management at the appropriate level to inform or drive action
- Liaise with external clients, law enforcement, and regulatory bodies ensuring accurate and timely communications.
- Assess existing and emerging risks and design programs to address the risks.
- Maintain a program to monitor the claims platforms and operations for data integrity risks and work with business owners through resolution of any issues identified
- Actively communicate and collaborate with management from various departments regarding remediation efforts, impacts on clients and providers, and communications with clients and providers
- Develop educational tools and training for staff and management on regulatory and customer requirements regarding the Special Investigation scope of activities and ensures adherence to these requirements.
- Provide subject matter expertise for staff on fraud investigations, facility and vendor audit and opportunity teams
- Oversee all reporting to clients and regulatory bodies related to the Fraud, Waste, and Abuse program
- Develop and maintain robust organizational and department policies and procedures to ensure compliance with industry standards, federal, and state requirements
- Maintain knowledge of emerging and leading practices and other relevant topics within the industry and implement new practices and protocols as appropriate to the organization.
- Other duties as assigned
Education and Experience:
- Bachelor’s degree in Business, Criminal Justice, Health Care Administration, or related field
- 10 years experience in insurance, managed care operations, or regulatory oversight of health care programs
- 5 years direct experience in investigations, audit or regulatory compliance
- 3 years experience in a supervisory role
- Extensive knowledge of investigative techniques, health care operations, government regulations
- Keen analytical skills that support tactical and strategic decision making
- Strong written, oral, interpersonal and presentation skills to communicate complex information to team members, senior leadership, clients, and regulatory bodies
Salary range is $150,000.00 – $157,000.00 plus bonus incentive
