Director, Business Compliance (Coding & Risk Stratification)

Aledade • Arlington, VA

289d

About The Position

Aledade's Compliance & Ethics organization is searching for an experienced, data-driven healthcare compliance leader. This critical role will use innovative, technology-driven solutions to improve patient outcomes while ensuring compliance with regulatory and ethical standards. The Business Compliance Director will proactively ensure Aledade adheres to relevant laws, regulations, and internal policies. This will be achieved by working closely with Aledade's Legal-Regulatory team to provide compliance support for all new and ongoing programs and business initiatives, synthesizing complex regulatory requirements, and providing the business with actionable compliance requirements. This position will help the business teams operationalize regulatory and contractual requirements in order to meet business objectives.

Requirements

• Bachelor's degree.
• 10+ years of work experience, ideally in the healthcare industry.
• 7 years of experience in healthcare compliance, and a minimum of 5 years of experience in coding and billing compliance.
• Strong understanding of healthcare regulations, including HIPAA, Stark Law, Anti-Kickback Statute, and other relevant regulations.
• Excellent communication and interpersonal skills, with the ability to present complex information clearly and concisely.
• Ability to work independently and as part of a team.
• Strong analytical and problem-solving skills.

Nice To Haves

• Juris Doctor (JD).
• Certified in Healthcare Compliance.
• Experience in value-based care healthcare delivery model.
• Experience chairing/leading compliance committees.
• Experience presenting and reporting to the Board of Directors.

Responsibilities

• Lead the Coding, Risk Stratification, and Billing Compliance Sub-Committee, including an Overpayments Program.
• Govern the Practice Partnership Integrity Program.
• Develop and implement compliance programs and procedures to ensure compliance with all applicable laws, regulations, and internal policies related to value-based care (Medicare Shared Savings Program and Medicare Advantage).
• Provide compliance support for all new and ongoing programs and business initiatives (e.g., Flex Program, Clinically Integrated Networks).
• Act as the primary compliance point of contact for Product and Technology teams.
• Identify and assess compliance risks and develop mitigation strategies.
• Provide Compliance training and education.
• Stay up-to-date on changes in laws, regulations, and internal policies.
• Work closely with other Aledade departments to ensure compliance with all applicable laws, regulations, and internal policies.

Benefits

• Flexible work schedules and the ability to work remotely are available for many roles.
• Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners.
• Robust time-off plan (21 days of PTO in your first year).
• Two paid volunteer days and 11 paid holidays.
• 12 weeks paid parental leave for all new parents.
• Six weeks paid sabbatical after six years of service.
• Educational Assistant Program and Clinical Employee Reimbursement Program.
• 401(k) with up to 4% match.
• Stock options.
• And much more!

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Industry: Professional, Scientific, and Technical Services
• Education Level: Bachelor's degree