Director, Compliance
Apply NowCompany: Equality Health
Location: Scottsdale, AZ 85254
Description:
About the Organization:
Equality Health, LLC is a Phoenix-based whole-health delivery system focused on transforming value-based care delivery with population specific programs that improve access, quality, and member trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. Through an integrated technology and services platform, culturally competent provider network and personalized Care Model, Equality Health helps managed care plans and health systems improve outcomes for diverse populations while simultaneously making the transition to risk-based accountability.
About the Role:
The Senior Director of Compliance will oversee the corporate compliance program that covers multiple lines of business and across multiple states, and includes compliance with the rules and regulations of the Centers for Medicare and Medicaid Services, as well as state Medicaid agencies. Responsibilities include, but are not limited to, the development and standardization of policies and procedures for compliance, auditing and monitoring, training and education, compliance investigations, and reporting.
Key Responsibilities:
Required Skills & Qualifications:
Disclaimer: This job description may not be inclusive of all assigned duties and responsibilities, or aspects of the job described, and may be amended at any time at the sole discretion of the employer
Equality Health, LLC is a Phoenix-based whole-health delivery system focused on transforming value-based care delivery with population specific programs that improve access, quality, and member trust. Our mission is to ensure diverse populations receive quality healthcare that improves and enriches their lives. Through an integrated technology and services platform, culturally competent provider network and personalized Care Model, Equality Health helps managed care plans and health systems improve outcomes for diverse populations while simultaneously making the transition to risk-based accountability.
About the Role:
The Senior Director of Compliance will oversee the corporate compliance program that covers multiple lines of business and across multiple states, and includes compliance with the rules and regulations of the Centers for Medicare and Medicaid Services, as well as state Medicaid agencies. Responsibilities include, but are not limited to, the development and standardization of policies and procedures for compliance, auditing and monitoring, training and education, compliance investigations, and reporting.
Key Responsibilities:
- Maintains up to date knowledge of federal and state regulations applicable to various lines of business.
- Ensures corporate policies are accurate, current and in compliance with federal and state regulations.
- Reviews policies and procedures, clinical and non-clinical.
- Interprets and disseminates information on regulatory and compliance matters.
- Educates and trains all employees regarding compliance topics.
- Manages compliance hotline process, which includes investigation, follow up, and corrective action if necessary.
- Conducts internal audits to ensure compliance with Stark, Anti-kickback, Conflicts of Interest, Fraud, Waste and Abuse, and other relevant laws and regulations.
Required Skills & Qualifications:
- At least 8 years in healthcare compliance with federal programs including Medicaid and Medicare.
- Strong understanding of Medicare and Medicaid reimbursement, Fraud, Waste and Abuse, HIPAA, Anti-Kickback Statute, Stark and state healthcare privacy laws.
- Direct Care/Clinical Compliance experience preferred
- Bachelor's Degree in related field
- Compliance Certification preferred
- Excellent communication skills
- Good interpersonal and organizational skills
- Some travel may be required
Disclaimer: This job description may not be inclusive of all assigned duties and responsibilities, or aspects of the job described, and may be amended at any time at the sole discretion of the employer