Compliance & Integrity Director

ChenMed

1d•$140,268 - $200,383•Onsite

About The Position

The Director of Compliance & Integrity (Compliance Oversight and Audit) is a key leadership role responsible for designing, implementing, and maintaining ChenMed’s audit and monitoring program—with a focus on coding audit oversight and risk-based compliance monitoring—and for driving compliance efforts across key risk areas, including risk adjustment, growth and revenue integrity, and HIPAA privacy & security. This position collaborates with the Compliance leadership to monitor and respond to emerging regulatory developments affecting the organization. This role will also strategize the integration of artificial intelligence and advanced analytics tools to modernize and scale audit functions. The ideal candidate combines deep expertise in healthcare compliance with leadership capability, experience overseeing compliance audits, intellectual curiosity about new technology, and a commitment to ChenMed's Purpose: the urgent pursuit of more good days.

Requirements

Expert-level business acuity with advanced understanding of healthcare compliance, audit, and regulatory risk management frameworks.
Demonstrated ability to design and operationalize risk-based audit and monitoring programs in a complex healthcare organization; experience building compliance infrastructure from the ground up, scaling programs during growth, or transforming inherited frameworks.
Strong analytical, critical thinking, and problem-solving skills.
Proven leadership ability.
Excellent written and verbal communication skills, including the ability to present complex findings clearly to executive and clinical audiences.
High ethical standards, integrity, and the professional courage to raise concerns and enforce standards consistently; demonstrated commitment to operating with accountability.
Alignment with ChenMed's Core Values of Love, Accountability, and Passion; demonstrated ability to build and lead teams with integrity, hold others accountable to high standards, and drive toward organizational objectives with genuine care for outcomes and people.
Ability to build collaborative relationships across departments and influence without direct authority.
Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook; competent in audit management software or GRC systems preferred.
Ability and willingness to travel locally, regionally, and/or nationally up to 25% of the time.
Spoken and written fluency in English.
This job requires use and exercise of independent judgment.
Master's degree in Business Administration (MBA), Health Care Administration (MHA), Health Informatics, Law (JD), or a related field required; or a Bachelor's degree with substantial additional healthcare compliance or auditing experience may be considered in lieu of the graduate degree on a year-for-year basis.
A minimum of seven (7) years' progressive work experience in healthcare compliance, healthcare auditing, healthcare regulatory counsel, or related risk management roles required.
Demonstrated experience in Medicare Advantage compliance, risk adjustment, value-based care regulatory programs; enterprise-scale compliance program design and scaling strongly preferred.
Certification (one of the following required): Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), or equivalent healthcare coding and auditing certification from AAPC or AHIMA, Licensed Attorney with healthcare compliance, regulatory, or privacy focus (JD + healthcare-specific experience or continuing education).

Nice To Haves

Comprehensive understanding of HIPAA Privacy and Security Rules, MCMG requirements, and federal healthcare fraud, waste, and abuse laws (Anti-Kickback Statute, False Claims Act) and ability to translate into actionable controls and procedures.
Ability to leverage data analytics, AI tools, or technology platforms to enhance audit and compliance functions.
Experience with AI-assisted audit tools, data analytics platforms, or healthcare compliance technology is a plus.
Experience conducting attorney-led or privileged assessments and managing workflows; ability to work closely with legal counsel while maintaining privilege a plus
Additional credentials that strengthen candidacy: Certified in Healthcare Privacy Compliance (CHPC), Certified in Healthcare Privacy & Security (CHPS), or relevant healthcare privacy law credentials, Artificial Intelligence Professional in Healthcare Compliance (AIP-HC)

Responsibilities

Designs, implements, and maintains a structured audit and monitoring program specific to ChenMed's value-based care model, aligned with CMS requirements, OIG guidance, and applicable federal and state regulations encompassing Risk Adjustment Data Validation (RADV), Medicare Communications & Marketing Guidelines (MCMG), HIPAA Privacy and Security, and other risk areas.
Develops and executes a risk-based annual audit work plan.
Leads, expands and oversees the Coding Audit team and professional development.
Prepares to transition to strategic direction as the function scales while maintaining accountability for audit outcomes.
Conducts periodic audits of privacy and security practices, policies, and controls.
Collaborates with IT, Information Security, Operations, and Legal to identify and remediate potential vulnerabilities related to protected health information (PHI).
Assists the Compliance & Privacy Officer in breach risk assessments and response activities, as needed.
Maintains accurate documentation and prepares clear, actionable audit reports and presents findings to the Compliance leadership, senior leadership, and relevant stakeholders.
Collaborates cross-functionally to drive corrective action, conduct compliance gap analyses, and delivers training programs ensuring staff understand regulatory requirements and compliance obligations.
Champions the integration of artificial intelligence and data analytics tools to enhance audit efficiency, accuracy, and scope, building team competency in the use of emerging audit technologies, ensuring staff are prepared to work in an increasingly data-driven environment.
Performs other duties as assigned and modified at manager's discretion.