Director of Regulatory Compliance

Appalachian Regional Healthcare, Inc.•Lexington, KY

6h•Hybrid

About The Position

The Director of Regulatory Compliance provides leadership and guidance to the Compliance Department on compliance with applicable statutes and regulations, including HIPAA, the False Claims Act, the Anti-Kickback Statute, and the Stark Law. The role recommends audit work plans, helps identify compliance risk areas, develops and implements system-wide compliance audits and investigations of high-risk areas, and assists with developing and annually updating policies and procedures. The Director reviews programs, activities, contracts, and practices for compliance; analyzes data from databases and software systems; follows up on audit and investigation findings; prepares reports and recommendations; and supports compliance education. The role manages Compliance Specialists, maintains professional competence and compliance certification, and coordinates with compliance leaders on the department’s annual work plan and risk assessment. The position is hybrid (remote/on-site), requires residence in Kentucky or West Virginia, and may require occasional travel of up to 20%.

Requirements

Bachelor’s degree required.
Currently hold, or obtain within 12 months of hire, a Certification in Health Care Compliance or Health Care Privacy.
Five years’ experience in a health care setting.
Ability to research and understand complex compliance requirements, including state and federal fraud and abuse laws, and communicate them to diverse individuals.
Strong writing and analytical skills.
Ability to convert compliance regulations into practical audit tools or scope documents.
Excellent communication and collaboration skills.
Ability to independently develop and execute complex investigations and compliance reviews.
Demonstrated leadership abilities.
Ability to maintain confidentiality and handle sensitive information with discretion and professionalism.
Ability to manage multiple deadlines and projects simultaneously.
Must reside in Kentucky or West Virginia.

Nice To Haves

Juris Doctorate or master’s degree preferred.

Responsibilities

Develop comprehensive compliance audits and investigations in consultation with other Compliance Department members.
Provide guidance on compliance with applicable statutes and regulations, including HIPAA, the False Claims Act, the Anti-Kickback Statute, and the Stark Law.
Assist in developing policies and procedures and ensure they are updated annually.
Generate reports and analyze data from databases and software systems across ARH.
Periodically review contracts for compliance with ARH policies and governmental regulations.
Perform and document audit and investigation follow-up to ensure ongoing monitoring and successful implementation of requested corrective action plans.
Prepare clear, comprehensive written audit reports explaining the process and methodology, results, root cause analysis, and recommendations.
Discuss audit results with personnel at all levels across the system and assist with education as appropriate.
Manage Compliance Specialists.
Maintain awareness of changes in statutes, regulations, and compliance principles and practices to maintain professional competence.
Review programs and activities affected by industry regulations and recommend changes to address non-compliant company procedures and practices.
Review the Office of Inspector General’s work plan and assist in creating compliance audits addressing areas of concentration.
Research and respond to compliance inquiries.
Coordinate with the Chief Compliance & Privacy Officer and the Director of Coding and Billing Compliance to develop the Compliance Department’s annual work plan.
Participate in the annual risk assessment and make practical recommendations for process or policy improvements.
Maintain compliance certification.
Provide education on HIPAA and fraud and abuse laws as appropriate.
Perform other duties as assigned.