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Director, Compliance (Healthcare Revenue Operations)

Denver, CO, USA | AHLA

  • Industry:
    Non-Profit / Social Enterprise
  • Position Type:
  • Functions:
    Regulatory Affairs
    Legal / Compliance
  • Experience:
    10-12 years
Job Description:
70 people have viewed this job

Reports to Vice President, Compliance and serves as member of his/her leadership team;

Manages day-to-day compliance program for Revenue Operations for dialysis business unit including, but not limited to the following departments Patient Admissions, Patient Registration, Insurance Management and Education, Payor Contracts, Medicare Advantage Team, and other supporting teams;

Supports VP with compliance special projects related to Revenue Operations and other business units;

Leads annual risk assessment process and development of annual compliance plan;

Develops, modifies, communicates, and implements policies and procedures;

Develops and implements compliance communications to key stakeholders;

Develops, modifies, and implements compliance training to key stakeholders;

Develops and executes annual monitoring plan, including implementation of corrective actions, where needed;

Partners and collaborates with senior leadership and legal counsel to develop guidance on all new and current business initiatives;

Travel required Minimal;

No direct reports.


Requirements


Bachelor’s degree required; JD/CPA/MBA or other relevant advanced degree or certification required;

Certificate in Healthcare Compliance preferred;

Minimum of 10 years’ experience as a legal or compliance professional responsible for the development, implementation and/or sustaining of an effective compliance program;

Preferred experience in healthcare industry dealing with federal healthcare program laws including, but not limited to Anti-Kickback Statute, False Claims Act, Stark Law, and Civil Monetary Penalty Law;

Preferred experience working with

Medicare Advantage regulations and Medicare Managed Care Manual;

CMS Conditions for Coverage (CfC) and Conditions for Participation (CfP), and other CMS Manuals;

Multiple insurance plan types (Commercial, Medicare Parts A-D, Medicaid)


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