Director of Compliance

 

Director of Compliance Auditing

The Director of Compliance Auditing is responsible for leading and overseeing Pinnacle’s compliance audit program which includes developing, implementing and maintaining audit processes to assess compliance with regulation, payor guidelines, accreditation standards, and applicable laws. This role will guide the compliance risk assessment process and annual compliance audit plan and will supervise a team of compliance auditors.

Responsibilities:

• Design, implement, and manage a comprehensive compliance risk assessment and compliance audit plan, as part of company-wide risk management effort
• Oversee risk-based audits related to billing, coding, clinical documentation, DEA, and regulatory compliance
• Oversee responses to regulatory or payor audits
• Regularly evaluate and improve audit methodologies and tools, and adjust audit strategies according to regulatory changes
• Effectively communicate the audit plan, risk trends, and proposed changes
• Review audit findings, identify trends, and ensure appropriate corrective action plans; partner with operations and clinical teams to ensure corrective action plans are completed; maintain accurate documentation of audits, findings, and corrective actions
• Perform management-requested advisory or special project engagements
• Participate in and make important contributions to steering committees and working groups
• Partner with other teams to enhance quality documentation of clinicians, including input on design of electronic health record systems
• Lead investigations and conduct audits
• Collaborate with legal, operational, and clinical teams to resolve compliance risk
• Develop and deliver compliance training
• Recruit, train, and mentor compliance audit teammates; set and monitor performance goals and ensure professional development for team members
• Promote a culture of compliance and ethical behavior
• Perform other related duties as assigned

Requirements:

• Bachelor’s degree
• Minimum of seven (7) years of progressive experience in healthcare auditing, compliance, or risk management.
• Minimum of three (3) years of leadership experience overseeing audit, compliance, or risk functions.
• Experience working with payer guidelines, regulatory audits, and healthcare compliance frameworks.
• Must possess a current valid driver’s license in good standing in state of employment and be insured by a designated carrier. This role is required to drive for company
  purposes.
• Travel up to 25%. Overnight travel may be expected for this role.
• Travel may include site audits, investigations, leadership meetings, and regulatory or payer-related engagements

 

Preferred

• Master's degree in healthcare administration, business administration, or related field
• One or more of the following certifications:
  • CHC (Certified in Healthcare Compliance)
  • CHPC (Certified in Healthcare Privacy Compliance)
  • CCEP (Certification Compliance Ethics Professional)
  • CIA (Certified Internal Auditor)
  • Experience in:
    • Audit program development
    • Enterprise risk assessment,
    • Policy and procedure development
    • Training curriculum design
    • Regulatory and payer audit response

 

Pinnacle Treatment Centers is an equal employment opportunity employer and makes employment decisions based on merit and other legitimate business considerations. We want to have the best available persons in every job. Company policy prohibits unlawful discrimination based on race, traits historically associated with race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), parental leave, national origin, gender, gender identity, gender expression, age, ancestry, physical or mental disability, military and veteran status, marital status, sexual orientation, genetic characteristics or information, political affiliation, non-merit based factors or any other consideration made unlawful by applicable federal, state, or local laws. It also prohibits discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.