Director of Regulatory Compliance

Appalachian Regional Healthcare•Lexington, KY

7d•Hybrid

About The Position

The Director of Regulatory Compliance will provide leadership and guidance to the Compliance Department regarding compliance with applicable statutes and regulations, including HIPAA, the False Claims Act, the Anti-Kickback Statute, and the Stark Law. The Director of Regulatory Compliance will make audit work plan recommendations and assist in the identification of compliance risk areas. The Director of Regulatory Compliance will assist in the development of policies and procedures, and ensure such policies and procedures are updated annually. The Director of Regulatory Compliance will develop and implement system-wide compliance audits and investigations of high-risk areas system-wide to ensure overall compliance.

Requirements

Bachelor’s Degree required
Five years’ experience in a health care setting.
Ability to research and understand compliance requirements of substantial complexity, including state and federal fraud and abuse laws and relay such information to a diverse group of individuals.
Strong writing and analytical skills.
Ability to convert compliance regulations into logical and 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.

Nice To Haves

Juris Doctorate or Master’s degree preferred.
Currently have, or obtain within 12 months of hire, a Certification in Health Care Compliance or Health Care Privacy.

Responsibilities

Responsible for the development of comprehensive compliance audits and investigations in consultation with other Compliance Department members.
Provide guidance regarding compliance with applicable statutes and regulations, including HIPAA, the False Claims Act, the Anti-Kickback Statute, and the Stark Law.
Assist in the development of policies and procedures, and ensure such policies and procedures are updated annually.
Generate reports and analyze data from numerous databases and software systems across ARH.
Periodically review contracts for compliance with ARH policies and governmental regulations.
Perform and document audit/investigation follow-up activities to ensure ongoing monitoring and that any requested corrective action plans are successfully implemented.
Prepare clear, comprehensive written audit reports that include sufficient detail to explain the audit process and methodology, results, root cause analysis, and recommendations.
Ability to clearly and articulately discuss audit results with all levels of personnel system-wide and assist with education as needed and appropriate.
Management of Compliance Specialists.
Maintain awareness of changes in statutes and regulations as well as compliance principles and practices in order to maintain professional competence.
Reviews all relevant programs and activities affected by industry regulations and recommends changes to address company procedures and practices that are non- compliant.
Review the Office of Inspector General’s work plan and assist in the creation of compliance audits that address areas of concentration.
Research and respond to compliance inquiries.
Coordinate with the Chief Compliance & Privacy Officer and the Director of Coding and Billing Compliance in the development of the Compliance Department’s annual workplan.
Participate in annual risk assessment and makes practical recommendations for process and/or policy improvements.
Maintains compliance certification.
Provides education on HIPAA and fraud and abuse laws as appropriate.
Perform other duties as assigned.