Director of Compliance

Essen Medical Associates•New York, NY

21h

About The Position

At Essen Health Care, we care for that! As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from women’s health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program. Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary The Director of Compliance is responsible for leading and coordinating the organization’s compliance program across clinical operations and the full revenue cycle, ensuring adherence to all applicable federal, state, and local laws, regulations, and payer requirements. The Director partners with Senior Management to define and communicate the compliance mission and vision and to design, implement, and continuously improve policies, procedures, education, and monitoring tools that support safe, compliant, and financially sound care delivery. This role has specific accountability for payer audit activities and for managing compliance risk related to coding, billing, documentation, and reimbursement.

Requirements

At least five (5) years of progressive experience in healthcare compliance, including prior management or leadership responsibility (multi-site or large group practice experience strongly preferred).
A minimum of two (2) years’ experience in medical coding and reimbursement, auditing, or healthcare clinical activities; experience bridging both clinical and revenue cycle compliance is strongly preferred.
Demonstrated experience managing RAC, CMS, and commercial payer audit processes, including responses, appeals, and corrective action plans.
Comprehensive understanding of the healthcare regulatory environment, including CMS, OIG, HIPAA, Stark, Anti-Kickback Statute, and state-specific requirements, as well as payer contract and policy compliance.
Proven ability to conduct and oversee complex compliance investigations, analyze root causes, and implement sustainable corrective actions.
Ability to plan and execute non-routine assignments under changing conditions, manage multiple priorities, and meet strict deadlines.
Advanced computer skills, including Microsoft Word, Excel, PowerPoint, and familiarity with EHR and practice management / billing systems, especially eCW.
Bachelor’s degree or higher in business, healthcare administration, health information management, nursing, or another healthcare-related field.
Certification in Healthcare Compliance (CHC) or Certification in Compliance & Ethics Professional (CCEP) required.

Nice To Haves

Certification in Medical Coding or Auditing (e.g., CPC, CCS, CPMA) preferred.
Certification in Healthcare Privacy Compliance (CHPC) and/or Certification in Healthcare Research Compliance (CHRC) preferred.

Responsibilities

Manage key compliance program activities at the direction of the Chief Compliance Officer (CCO), with a focus on both clinical and revenue cycle compliance.
Assist in establishing departmental goals and objectives that align with divisional and corporate strategies, and achieve those goals through effective leadership, strategic direction, and budget and business planning.
Analyze the OIG Work Plan, CMS guidance, payer policies, and other regulatory updates to support an annual risk-based audit and monitoring plan in collaboration with the compliance team and Executive Compliance Committee.
Design, plan, and oversee compliance monitoring and auditing activities in accordance with the annual plan, including coding, billing, documentation, privacy, and clinical operations reviews; delegate responsibilities and supervise staff to ensure timely completion and effective follow-up.
Document and report result of compliance activities and audits to the CCO and other senior leaders in a timely, clear, and actionable manner.
Lead or coordinate responses to audits performed by external entities (e.g., OCR, CMS, RAC/UPIC/CERT contractors, OIG, and commercial/Medicaid managed care plans), including record production, issue clarification, and development of corrective action plans.
Prepare and manage appeals of adverse audit decisions and work with internal stakeholders to address root causes and prevent recurrence.
Serve as an advisor to senior and operational leadership on compliance issues, identifying related opportunities for process improvement and risk reduction in both clinical workflows and revenue cycle processes.
Conduct or oversee internal compliance investigations and focused audits, including coding/billing and clinical documentation reviews; prepare detailed reports, recommend corrective actions, and monitor implementation to closure.
Monitor and interpret legal, regulatory, and payer policy developments affecting the organization’s operations and revenue cycle; communicate relevant changes and their implications to affected departments.
Maintain current knowledge of regulatory guidelines, government enforcement priorities, RAC and payer audit trends, and industry best practices in healthcare compliance.
Continually assess the effectiveness of compliance operations—people, processes, and technology—identifying vulnerabilities and opportunities for improvement and implementing practical, measurable solutions.
Assist in the design, development, implementation, and periodic evaluation of policies and procedures that support the Corporate Compliance Program, including those related to coding, billing, documentation, privacy, and security.
Identify areas of potential vulnerability and risk, develop and track corrective action plans, and provide guidance to operational leaders on remediation and ongoing monitoring.
Provide oversight for the development, implementation, and monitoring of compliance training materials, and personally conduct targeted compliance education for providers and staff as needed (e.g., coding/billing, documentation, audit findings, RAC readiness).