Director of Operations and Compliance

The Director of Operations and Compliance oversees the regulatory and compliance framework for the organization, ensuring adherence to federal, state, and contractual regulations. This role involves developing and managing policies, procedures, and training programs to minimize compliance risks, ensure audit readiness, and maintain the organization's regulatory standing.

Responsibilities:

• Design compliance training programs; foster a culture of compliance; ensure staff is well-versed in regulatory requirements
• Develop policies for claims processing, fraud prevention, data privacy, and compliance adherence across departments.
• Lead audits, investigate violations, and ensure corrective actions are taken for non-compliance issues.
• Cross collaborate with different departments to ensure compliance is being met
• Develop and maintain a compliance program in line with relevant regulations; serve as liaison for regulators and auditors; monitor changes in laws and regulations.
• Provide regular updates to leadership and stakeholders; develop reports on regulatory adherence and audit results.

Qualifications & Skills:

• Bachelor's degree
• 8+ years of experience in Operations and Compliance
• Knowledge of healthcare regulations
• Experience in regulatory audits, fraud investigations, and risk assessments.
• Strong leadership and communication skills.

Preferred Skills:

• Healthcare or TPA industry experience
• Certifications in healthcare compliance

Compensation: $120,000-$160,000
Salary is based on a range of factors that include relevant experience, knowledge, skills, other job-related qualifications.