The Director, Compliance will report directly to the General Counsel and Chief Compliance Officer and assist in the successful operation of an effective Corporate Compliance Program including primary leadership support of Program objectives and completion of the annual Effectiveness Review and related Work Plan(s).

The successful individual in this role must maintain a comprehensive understanding of the Values and ethical principles upon which ConcertoCare operates, as well as the highest level of personal and professional conduct. The Director, Compliance must remain objective and independent when completing assignments, and consistently demonstrate the ability to hold information in confidence.

This is a get into the weeds position that requires high energy, deep engagement, and a strong work ethic. This individual brings an incredible ability to act as a cross-functional team member across the market to accomplish goals and must demonstrate cooperation and collaboration across the entire organization and with ConcertoCare’s partners.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Oversee and manage all aspects of the compliance program and assist with the Privacy Program.
• Develop and administer ConcertoCare’s Compliance Program and Privacy Program through coordination with internal stakeholders, subject matter experts, and best practices.
• Lead the ConcertoCare’s Executive Compliance Committee (ECC) and prepare meeting minutes for the compliance program sub-committee(s) or work groups and other compliance meeting activities as needed.
• Periodically review and revise, as necessary, the Concerto’s Code of Conduct and Compliance Program Description, and present for approval to the ECC and Compliance Officer.
• Periodically review and revise, as necessary, the ConcertoCare privacy policies.
• Collaborate with internal and external auditors during audit and monitoring activities.
• Work with ConcertoCare management team members to develop appropriate action plans that address audit findings and introduce controls likely to prevent non-compliance performance. This includes tracking management action plans and corrective actions to ensure timely and effective resolution of identified deficiencies.
• Coordinate the work of a routine independent assessment of the plan’s Compliance Program Effectiveness and prepare for these results for the ECC and Chief Compliance Officer.
• Prepare and present regular written reports regarding Compliance activities for the ECC and Chief Compliance Officer.
• Prepare and present regular written reports regarding Privacy activities for the Privacy Officer.
• Maintain professional and technical knowledge of basic healthcare compliance legal and regulatory requirements, including subject matter expertise in Medicare and state Medicaid program requirements.
• Maintain professional and technical knowledge of HIPAA and state privacy requirements.
• Organize and manage administrative tasks involved in the oversight of key compliance risks.
• Oversee that all required background and exclusions screens have been performed in compliance with regulations and contractual requirements.
• Establish and administer open lines of communication, including but not limited to publishing and posting information on how to access the company’s anonymous hotline.
• Maintains subject matter expertise and serves as primary corporate resource for First Tier, Downstream and Related entity (FDR) services and supports the education and oversight of all FDR related compliance matters across the organization.
• Validates accuracy and completeness of regulatory reports.
• Champion compliance with the company’s Code of Conduct and take appropriate actions against suspected violations of the code.
• Collaborate with appropriate individuals in the escalation of an investigation of all reports of possible misconduct.
• Develops materials for use in education and communication.
• Oversee the completion of required compliance education and training by the workforce.
• Work closely with appropriate department concerning material risk areas oversight such as physician relationships, CMS General Compliance and Fraud, Waste, and Abuse prevention (as a Provider and FDR), coding and billing activities, privacy and security, and sales and marketing activities.
• Coordinates and organizes various compliance, risk, and quality assurance projects and manages documents.
• Works with team members to update and organize policies and procedures, including a tracking method for review of policies and procedures by employees and contracted vendors/agents.
• Maintains databases, produces, and monitors various reports from multiple systems (for example: learning management system).
• Assists with production and communication of compliance or related alerts, newsletters, and educational emails.
• Promote and adhere to the Code of Ethics and Business Conduct and the elements of the Corporate Compliance Program and exercise due diligence to ensure with policies and local requirements.
• Performs other duties as assigned/necessary.

QUALIFICATIONS

• Bachelor’s degree, or advanced degree.
• Active compliance certification; CHC, CHPC preferred.
• 3 to 7 years relevant experience in the healthcare industry preferred.
• Experience developing compliance programs, plans and infrastructure is required.
• A working knowledge of internal control and risk assessment techniques.
• A working knowledge of current best practices in FWA management.
• A working knowledge of HIPAA and privacy regulations.
• Adaptable and able to function in a fast paced, highly fluid startup environment.
• Strong communication skills with proven track record of success working with cross functional teams.
• Working knowledge of applicable regulations and state and federal laws.
• Computer skills and high competence with Microsoft Outlook, Word, Excel.

Base Salary/ Wage Range $130,000 to $150,000 plus annual bonus. Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace