Compliance Officer Jobs

About The Position

Requirements

• Bachelor's degree required in healthcare administration, nursing, health information management, business, or a related field.
• Certified in Healthcare Compliance (CHC) through the Health Care Compliance Association (HCCA) required, or must obtain within 12 months of hire.
• Minimum of 5–7 years of progressive healthcare compliance experience required.
• In-depth knowledge of federal and state healthcare regulations, OIG guidelines, Stark Law, Anti-Kickback Statute, and False Claims Act.
• Strong analytical skills with the ability to interpret complex regulatory guidance and apply it operationally.
• Excellent written and verbal communication skills, including the ability to present findings to Boards and C-suite leadership.
• Demonstrated ability to build collaborative relationships across clinical, operational, and administrative departments.
• High degree of integrity, discretion, and professional judgment.
• Proficiency with compliance management software, EHR platforms, and Microsoft Office Suite.

Nice To Haves

• Master's degree (MHA, MBA, MSN, JD) strongly preferred.
• Additional certifications such as CHPC, CPCO, RHIA, CCS, or CPC preferred.
• Direct experience with LTACH and/or IRF regulatory requirements strongly preferred.
• Prior experience managing corporate or multi-facility compliance programs preferred.
• Familiarity with CMS Conditions of Participation, IRF-PAI, and LTACH PPS billing strongly preferred.

Responsibilities

• Design, implement, and maintain a comprehensive corporate compliance program consistent with OIG guidelines, CMS Conditions of Participation (CoPs), and industry best practices.
• Develop and regularly update compliance policies, procedures, and the Code of Conduct.
• Establish and monitor annual compliance work plans with measurable objectives and risk-based priorities.
• Lead the Compliance Committee and report program status and findings to the Board of Directors and executive leadership.
• Ensure compliance with LTACH-specific criteria, including average length of stay (ALOS) requirements, patient criteria (25-day rule), and CMS site-neutral payment policies.
• Oversee adherence to IRF coverage criteria including the 60% Rule (Compliant Patient Criteria), required physician oversight, and individualized overall plan of care (IPOC) documentation standards.
• Monitor compliance with Medicare and Medicaid billing and reimbursement rules specific to LTACH and IRF Prospective Payment Systems (PPS).
• Stay current with CMS transmittals, Final Rules, and OIG Work Plans relevant to LTACH and IRF settings.
• Direct internal auditing activities including medical record reviews, billing audits, and documentation audits for LTACH and IRF criteria compliance.
• Oversee third-party compliance audits and coordinate responses to Recovery Audit Contractor (RAC), MAC, CERT, and ZPIC/UPICs reviews.
• Analyze audit findings, identify trends, and implement corrective action plans (CAPs).
• Monitor outcomes of CAPs to ensure sustainability and effectiveness.
• Develop and deliver compliance training programs for clinical, coding, billing, and administrative staff.
• Ensure new employee compliance orientation and annual refresher training completion.
• Create targeted education based on audit findings, regulatory changes, and identified risk areas.
• Manage the confidential compliance hotline and investigate all reported compliance concerns promptly and thoroughly.
• Conduct root cause analyses and coordinate corrective actions in partnership with HR, Legal, and Operations.
• Oversee voluntary self-disclosure obligations and coordinate with legal counsel on government investigations or inquiries.
• Maintain accurate and confidential records of all compliance investigations.
• Conduct and document annual compliance risk assessments across LTACH and IRF operations.
• Identify emerging regulatory risks and proactively communicate risk mitigation strategies to leadership.
• Collaborate with Revenue Cycle, Clinical Operations, and Case Management teams to address billing and documentation vulnerabilities.
• Serve as the primary point of contact for CMS surveys, state health department surveys, and accreditation reviews (e.g., The Joint Commission, DNV).
• Coordinate responses to Medicare Administrative Contractor (MAC) correspondence and government contractor reviews.
• Maintain relationships with legal counsel, industry associations, and regulatory bodies.