Director, Compliance Investigations

Ensemble Health Partners•Work at Home - Ohio - Other, OH

8d•$129,000 - $193,500•Remote

About The Position

The Compliance Director, Investigations will provide Compliance Program leadership for assigned service lines and/or locations, with primary accountability for the oversight of Compliance investigations — ensuring that reported concerns and suspected violations of the Compliance Program are evaluated, investigated, and resolved. This leader also serves as a trusted partner to client compliance partners, operational and executive leadership, promoting a culture of integrity, accountability, and continuous improvement while mitigating organizational risk.

Requirements

Healthcare compliance certification (CHC, CHPC, CHRC, CCEP, or equivalent).
Bachelor's degree in Healthcare Administration, Business Administration, Law, Finance, or a related field.
8+ years of progressive healthcare compliance, regulatory, audit, risk management, or revenue cycle leadership experience.
5+ years of leadership experience managing teams and compliance programs.
Strong knowledge of healthcare regulatory requirements, including False Claims Act, CMS, OIG guidance, and healthcare compliance frameworks.
Demonstrated experience conducting investigations, audits, and risk assessments.
Excellent communication, presentation, and executive stakeholder management skills.
Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.

Nice To Haves

Master's degree in Healthcare Administration, Business Administration, Public Health, Law, or related field.
Experience supporting large, multi-site healthcare systems or revenue cycle organizations.
Experience presenting compliance findings and recommendations to executive leadership and boards.
Demonstrated working knowledge of Revenue Cycle services and processes.

Responsibilities

Evaluate and manage compliance concerns and reports of suspected misconduct and perform and oversee investigations to ensure that all suspected violations of the Compliance Program are fully investigated and resolved.
Oversee the intake, triage, prioritization, and assignment of reported compliance matters, ensuring timely and consistent handling in accordance with Compliance Program requirements.
Coordinate the implementation of corrective action plans, monitoring progress and completion, and escalating as required — including overseeing complex overpayment/refund activities, claim correction efforts, and the resolution of systemic issues.
Develop and perform training associated with investigations, government and payer coding audits, and settlements.
Take, research as needed, and respond to day-to-day compliance questions, including providing effective guidance related to Compliance Program requirements and regulatory risk mitigation.
Maintain awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestically and internationally through personal initiative, continuing education, and peer-to-peer networking.
Prepare and provide reports of investigation activities, findings, and outcomes as requested by Compliance Leadership.
Serve as the Compliance Liaison to assigned Ensemble clients and/or service lines, as assigned by leadership.
Act as the primary compliance point of contact for assigned clients and/or service lines, building trusted relationships with client compliance officers and operational leaders.
Facilitate timely, two-way communication of compliance matters, regulatory updates, and Compliance Program expectations between Ensemble Compliance and assigned clients and/or service lines.
Attend and support recurring client and service line compliance meetings and align compliance activity with client-specific policies and requirements.
Identify, triage, and escalate compliance concerns arising within assigned clients and/or service lines, and support resolution and follow-up.
Support client-facing audit, monitoring, and reporting activities, and coordinate distribution of compliance communications (e.g., the monthly Regulatory Compliance Digest) to assigned stakeholders.