Director of Compliance

Job Summary
Ensures companywide knowledge, adherence, and compliance with healthcare billing & privacy laws and regulations including CMS guidelines as well as applicable state, local, and federal laws & regulations.

Major Responsibilities/Activities

• Conduct Internal Compliance Investigations and Reviews throughout the billing process and provide detailed recommendations to Compliance Officer and Management.
• Manage team responsible for Quality Assurance Process, track, analyze and communicate the results of audit process to leaders and develop process improvements based on audit results.
• Identify needs and opportunities to improve compliance initiatives; develop and communicate policies & procedures as needed for successful implementation
• Serve as ongoing resource to all departments and all locations for Compliance related inquiries
• Assist management in process improvements and monitor these improvements for consistent implementation.
• Coordinate, manage, and communicate reviews between internal staff, clients, and external parties as necessary to ensure alignment and timely response
• Coordinate Internal Response to all Government, Payor, and Client Initiated Audits, communicate findings to internal staff, conduct appeals to Payor as necessary.
• Maintain up-to-date knowledge of all relevant billing & privacy laws and regulations and communicate internally as appropriate
• Participate in internal committees to provide compliance education & support
• Develop Educational Materials and Conduct Ongoing Compliance Training
• Develop Written Communications for distribution to external clients as regulations are updated
• Investigate, respond to, and Communicate response to all Compliance Related Inquiries in a timely manner
• Collaborate with other internal staff to identify appropriate corrective actions when problems arise to not only address the problem but also prevent further occurrences
• Consistently support and demonstrate the company mission and values
• Conduct all job tasks, duties, and interactions with professionalism, respect, a positive attitude, and in accordance with company policies and applicable government regulations

Other Responsibilities/Activities

• Build and maintain strong relationships with key internal staff and external contacts, demonstrating credibility and representing company values in a positive manner
• Completion and/or involvement in special projects
• Participate in company-sponsored events
• Participate in industry-related conferences, trade shows, etc.

Performance Success Factors

• Leads and performs by example to promote cross-functional teamwork and unity
• Communicates effectively and shares information company-wide and externally as needed to ensure high level of performance and strong company reputation
• Organization is knowledgeable and compliant with relevant laws and regulations

Required Education, Skills, & Experience

• Bachelors degree in healthcare, business, or related field with at least 3 years of direct experience in healthcare compliance & reimbursements or 6+ years of direct experience in healthcare compliance & reimbursements
• Strong, demonstrated knowledge of all aspects of healthcare compliance
• Demonstrated understanding of medical billing cycle and payor rules and regulations
• Strong decision-making, problem-solving, critical thinking, and analytical skills with the ability to identify the cause and effect of problems and determine appropriate next steps/corrective action
• Ability to develop effective educational materials and train others to achieve results
• Willing, eager, and able to learn and interpret new laws and directives as they are issued and apply to business operations
• Strong collaboration skills with the ability to work across department lines to achieve results
• Willing and able to travel, sometimes on short notice, to various business sites, conferences, etc.
• Strong sense of confidentiality and professionalism regarding medical and financial information
• Highly organized with the ability to manage time, prioritize work effectively, and remain productive amid frequent interruptions
• Demonstrates professionalism, confidence, and credibility with the ability to remain impartial and objective while enforcing policies in a consistent manner
• Excellent oral and written communication skills, facilitation skills, and presentation skills
• Must be able to communicate and manage sensitive information in a professional, composed, and confident manner
• Strong customer service and interpersonal skills
• Ability to effectively manage multiple projects and tasks at a time and meet deadlines
• High level of accuracy and attention to detail
• Must be committed to the highest level of business and ethical standards and consistently display integrity and behavior in line with the company’s mission and values
• Proficiency in Microsoft Word, Excel, Outlook, and Power Point
• Willing and able to adapt to changes in work environment, procedures, priorities, and job duties
• Strong work ethic with the ability to identify what needs to be done, complete tasks, and meet deadlines with little supervision

Preferred Education, Skills, & Experience

• Healthcare compliance certification strongly preferred
• Clinical healthcare experience (paramedic, RN, etc.)
• Prior experience in EMS industry and/or ambulance billing
• Legal background a plus
• Prior experience in communications or public relations role
• Prior experience in a role of auditing the work of others and/or establishing operational processes and procedures

Working Environment/Physical Requirements

• General office environment
• Typing, sitting, standing, walking, some light lifting
• Use of basic office equipment such as PC, fax, printer, copier, phone
• Flexibility to work extended hours to support the business as required
• Travel is required, sometimes on short notice; mostly short trips