LHH is recruiting a Director of Compliance for a greater Cleveland healthcare organization.
The Director of Compliance will work closely with clinical, operational, and business leaders; supervise compliance resources; and serve as a trusted legal and compliance partner to executive leadership.
Responsibilities:
- Lead, evaluate, and continuously improve the organization's compliance program in alignment with industry best practices, applicable legal requirements, and recognized healthcare compliance guidance.
- Develop the annual compliance risk assessment and work plan, establishing monitoring, auditing, investigation, training, and corrective-action priorities.
- Manage compliance reporting channels and hotline matters; identify patterns, emerging risks, and opportunities for program improvement.
- Prepare clear, risk-based reporting for executive leadership and, as appropriate, the governing body.
- Partner with Operations, Revenue Cycle, Clinical Leadership, HR, IT, and Finance to translate compliance requirements into practical operational processes.
- Direct compliance monitoring and oversight of auditing related to provider documentation, coding, billing, medical necessity, and reimbursement.
- Partner effectively with internal and external coding professionals.
- Evaluate audit findings, identify systemic risk, and ensure corrective action, education, and follow-up monitoring are completed.
- Advise on Medicare and Medicaid requirements, overpayments and repayment obligations, False Claims Act exposure, and related reimbursement risks.
- Provide practical guidance regarding Stark Law, Anti-Kickback Statute, beneficiary inducement rules, Civil Monetary Penalties, and other healthcare fraud and abuse laws.
- Assess provider compensation arrangements, new service lines, locations, vendors, and business initiatives for regulatory risk.
- Manage compliance investigations, response, and remediation.
- Research and advise on healthcare regulatory, operational, and risk-management matters, providing clear and business-minded recommendations.
- Draft, review, and negotiate provider agreements, business associate agreements, confidentiality agreements, vendor contracts, and selected operational agreements.
- Support regulatory implementation, policy development, claims and litigation support, corporate transactions, due diligence, and integration activities.
- Supervise and support compliance and privacy resources responsible for day-to-day HIPAA and privacy administration.
- Advise on significant privacy incidents, breach determinations, patient-information issues, vendor privacy and security terms, and matters requiring legal analysis.
- Develop annual and targeted compliance education, including manager and provider guidance and training following audits or incidents.
- Promote open reporting, non-retaliation, and shared accountability for compliance across the organization.
- Track training completion and effectiveness and help build the compliance function as the organization grows.
Qualifications:
- Juris Doctor from an accredited law school preferred.
- Active license and good standing in a U.S. jurisdiction preferred, but not required. Ohio admission or eligibility to obtain appropriate Ohio status is a plus.
- At least five years of relevant legal and/or healthcare compliance experience, including meaningful healthcare regulatory experience.
- Working knowledge of healthcare compliance programs, HIPAA, healthcare fraud and abuse laws, and reimbursement and/or billing and coding risk.
- Experience conducting or managing internal investigations and developing practical corrective-action plans.
- Strong legal research, writing, judgment, and communication skills, with the ability to translate complex requirements into practical operational guidance.
- Ability to manage multiple priorities, work independently, exercise sound judgment, and recognize when an issue requires escalation.
Would you like to learn more about the Director of Compliance position that Special Counsel has available in Cleveland, Ohio? If so, then please submit your resume below. Or, visit our website at www.lhh.com to apply or consider other available opportunities with us.
Pay Details: $170,000.00 to $200,000.00 per year
Search managed by: Cheryl Jacobs
Equal Opportunity Employer/Veterans/Disabled
Military connected talent encouraged to apply
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