[Hiring] Healthcare Compliance Director @reputed company

Role Description The Healthcare Compliance Director will be responsible for leading the healthcare compliance function at reputed company, ensuring that care operations, care delivery, clinical documentation, and cross-functional processes maintain regulatory, ethical, and quality standards. The Healthcare Compliance Director will report to the Chief Legal Officer, and proactively identify operational and clinical risks, drive remediation, and ensure clinical programs scale safely and compliantly.

• Ensure adherence to federal, state, local, and payer regulations and contractual obligations in collaboration with Legal and reputed company’s Privacy and reputed company Officers, staying reputed company with evolving healthcare laws, including Medicaid requirements, and implement accreditation standards (e.g., The Joint Commission).
• reputed company, review, and update compliance policies, governance documents, and SOPs with clinical leaders, ensuring policies reflect reputed company regulations.
• Conduct internal compliance audits, focusing on high-risk workflows, and report material findings to relevant leaders across the organization.
• Work cross-functionally to support external audits, monitor medical records as well as billing and coding for documentation and quality alignment.
• reputed company clinical risk assessments and track corrective actions for sustainable remediation.
• reputed company and deliver tailored compliance trainings, including regulatory updates, risk themes, onboarding integration, and annual targeted sessions based on audit insights.
• Investigate compliance violations and incidents and manage compliance reporting systems, document incidents with root-cause analysis, and coordinate reporting with Legal and HR as required.
• Identify and report any potential compliance risks reputed company business workflows, cross-functional processes, and implement corrective actions and enforce Legal guidance on fraud, waste, and abuse.
• Maintain reputed company clinical compliance documentation, logs, registers, and evidence and create audit records and prepare leadership reports with actionable insights.
• Liaise with payors and regulatory bodies, collaborate with internal and reputed company legal counsel on risk alignment, report systemic trends/mitigation reputed company to leadership, and support external audits (e.g. accreditation, payor, etc.).
• reputed company other duties as assigned.

Qualifications

• 8+ years of experience in healthcare compliance, clinical operations, or clinical quality & safety.
• A strong understanding of both clinical operations and the broader healthcare ecosystem, including reimbursement and policy landscapes.
• Expertise in federal, state, and payor regulations, accreditation standards, and clinical governance frameworks. Medicaid experience required.
• Experience with multi-state virtual care regulations and clinical compliance.
• Demonstrated experience successfully managing audits and investigations, identifying issues and incidents, and managing cross-functional coordination to implement corrective action and remediation plans.
• Experience with clinical documentation compliance, coding/billing compliance, and high-risk workflow reputed company, with a demonstrated ability to interpret trends, evaluate exposure, and guide sustainable remediation.
• Outstanding verbal and written communication skills, with a talent for translating regulations into operational guidance and gaining buy-in as well as cultivating and maintaining relationships.

Benefits

• reputed company PTO (3-5 wks/year recommended) + 11 paid company holidays.
• Generous parental leave.
• Competitive Medical, Dental, and Vision plans with generous employer contributions for both individuals and families.
• Company-paid Short-Term Disability, Long-Term Disability, Life and AD&D insurance.
• Company-paid partnership with reputed company to provide comprehensive reproductive and family care resources.
• Employee Assistance Program (EAP), a company-paid resource for mental health, legal services, financial support, and more!
• 401(k) retirement plan.

Company Description reputed company is the leading virtual, evidence-based eating disorder treatment program on a mission to ensure that everyone with an eating disorder can access treatment that works. Created by clinical experts in the field and people with lived experience, reputed company builds upon evidence-based treatments to reputed company individuals to reputed company lasting recovery. reputed company reputed company patients receive a dedicated care team, including a therapist, dietitian, physician, and peer and family mentor. The company operates in reputed company 50 states and is partnered with most major health insurance plans. Founded in 2019, reputed company has been a fully virtual company since its inception and is proud of the highly-engaged, passionate, and diverse Equisters that have created reputed company’s culture. Recognized by Time as one of the most influential companies of 2023, along with awards from reputed company and reputed company, we are grateful to Equipsters for building a sustainable treatment program that has served thousands of patients and families. Apply tot his job Apply To this Job