Profile
Compliance Director (Medicaid, Healthcare, and Nonprofit Generalist)
Duties: Develop and implement Compliance Program, including a comprehensive Medicaid Compliance Program to prevent fraud, waste, and abuse. Develop and implement risk assessments and an annual compliance workplan, including an annual audit plan. Ensure and strengthen compliance with and understanding of confidentiality and privacy requirements, including HIPAA, 42 CFR Part 2, NYS Shield Law, OMH requirements, and NYC privacy laws. Work closely with the General Counsel, IT, and database staff to identify and address security risks. Develop and implement compliance policies and procedures, including necessary forms to adequately ensure compliance with state and federal laws, regulations, contracts, and best practices. Revise Policies and Procedures as needed to address changes in law. Monitor the organization for potential compliance violations and risk and investigate reports of suspected violations. Conduct audits to assess compliance with critical policies, procedures, and regulations. Design audit tools and audit report formats. Upon identification of non-compliance, provide support to staff by conducting a root cause analysis and corrective action, including training and compliance reviews. Participate in credentialing, fiscal, and other committees and meetings to assess risk and guide compliance activities. Convene and Chair Compliance Committee. Implement and manage procedures for HIPAA Business Associate Agreements and screening for excluded staff and vendors. Identify and implement procedures to strengthen compliance work. Regularly report to the General Counsel, Board of Trustees, and senior staff. Work closely with staff to ensure that compliance is integrated into quality assurance and quality improvement efforts. Participate in organization incident review committees, including conducting investigations. Keep up to date on compliance and regulatory requirements and identify and develop effective compliance tools and resources. Visit all locations and meet with staff on a regularly scheduled as well as spontaneous basis to assess risk, conduct investigations, and educate staff. Conduct education and training including Medicaid training, Code of Conduct, Whistleblower, and other compliance topics. Develop creative compliance education tools and activities such as email blasts, portal and newsletter postings, and Compliance Week activities. Engage in ad hoc tasks at the direction of the General Counsel, including administrative responsibilities.
Qualification and Experience
Qualifications: Master’s degree in Compliance, Healthcare, Business Administration or equivalent education and experience. Law Degree Preferred. CHC or CHPC certification a plus; 10+ years of progressive experience in compliance roles; Prior experience in a Medicaid-funded, healthcare setting required; 5+ years of experience managing projects; Good knowledge of legal requirements, procedures and compliance regulations including HIPAA, 42 CFR part 2, FERPA, Medicaid, OMH regulations, and other applicable regulations; Experience synthesizing laws, regulations, contracts, and working with outside auditors and regulators; Demonstrated ability to identify potential areas of compliance vulnerability and risk and to propose a course of corrective action; Experience developing and implementing audits; Experience developing and conducting trainings; Demonstrated acuity in integrity and professional ethics; Demonstrated problem solving skills; Excellent time management skills and ability to juggle multiple priorities; Excellent oral and written communication skills; and Facile in Microsoft Excel, SharePoint, and other programs to facilitate program management and compliance.
Additional info
Send updated resume with a cover letter. No phones calls, please.
Company info
Hiring Coordinator
CASES, Inc
151 Lawrence Street, 3rd Floor
Brooklyn, NY 11201