Director of Corporate Compliance for Billing

The Jewish Board • New York, NY

112d

About The Position

The Corporate Compliance department supports the agency in maintaining compliance in all areas of operations. The department focuses on promoting a culture of compliance, preventing, and detecting fraud, waste, and abuse, and educating staff on their rights to report suspected non-compliance. The Director of Corporate Compliance for Billing is responsible for supporting The Corporate Compliance Program throughout the enterprise, which entails reviewing and evaluating third party billing compliance issues/concerns within the organization. The Director of Corporate Compliance for Billing under the Chief Compliance Officer will coordinate with management and staff to ensure that the Jewish Board achieves consistently high levels of compliance with all applicable billing laws and regulations; policies and procedures and the code of conduct and will respond to any matter in a timely manner.

Requirements

• MS/MA/MBA/MPA/LCSW/LMSW required.
• Experience in related fields (i.e., Behavioral Health, CASAC, Public Health, Public Administration, Social Work)
• Experience with state regulators including but not limited to, OCFS, OMH, OPWDD, OMIG, OASAS, DOHMH, NYS DOH, and ACS.
• One year auditing experience preferred.
• Strong interpersonal and verbal communication skills, ability to engage staff at all levels of responsibility.
• Project management and organizational skills along with an ability to work independently.
• Experience in a not-for-profit or social service setting.
• Prior experience in interpretation of regulation and/or policy development and implementation preferred.
• Excellent organizational, time management, written and verbal communication skills.
• Proven analytical and problem-solving skills.
• Ability to attend agency meetings, held during business hours.
• Certification in Lean Six Sigma preferred.

Responsibilities

• Oversee internal billing/claims audits agency wide.
• Supervise the Billing Compliance Auditors.
• Contribute to the development and implementation of the Provider Compliance Program and Risk Management Plan.
• Ensure that billing/claims audits of services occur at least six times a year (every 2 months) and as directed.
• Identify areas of potential exposure and risk. Assist in the development of corrective action plans for the resolution of any risk issue and ensure implementation of same.
• Lead or participate in investigations of fraud, waste, and abuse of public funds.
• Research and maintain a matrix of regulatory updates division wide.
• Identify trends and patterns by reviewing compliance of all departmental procedures, policies, and practices to ensure compliance with agency requirements that mirror billing audits conducted by the Office of the Medicaid Inspector General (OMIG), Centers for Medicare and Medicaid Services (CMS), 3rd party vendors, and Medicaid Managed Care Organizations (MMCOs).
• Respond to alleged violations of rules, regulations, and policies, et al., evaluate complaints and/or recommend the initiation of any inquiry to their supervisor.
• Work collaboratively with program staff, and other support departments to address and mitigate identified areas of exposure.
• Coordinates the completion of regulatory mandated projects and supports the use of regulatory systems, organizes training activities as needed.
• Conduct training to staff around compliance needs, regulations and issues including facilitation of the Compliance arm of the agency.
• Participate in the agency wide accreditation preparation process and actual survey.
• Remain up-to-date and knowledgeable of all regulatory and guidance requirements.
• Participate and assist in coordinating Compliance Review Committee (CRC) meetings.
• Sustain an environment that fosters team member engagement, equity, inclusion and belonging. Establishes clear objectives connected to department and/or organizational strategic goals.
• Other duties as needed.

Benefits

• Hybrid work environment with some work in person at an office location and some work from home.
• Equal opportunity employer that does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, marital status, veteran status, or any other status protected by applicable federal, state, or local law.

What This Job Offers

• Job Type: Full-time
• Education Level: Master's degree
• Number of Employees: 1,001-5,000 employees