Director of Compliance

Description

This position is remote, but the individual must reside in the ACP service area - NY, MA, RI, NH, VT.

The individual in this position reports to the Chief Financial Officer and assists in overseeing the development, implementation, and ongoing review of the compliance program for the insurance-funded division of Autism Care Partners (ACP).?The individual in this position provides an independent and objective review which promotes and evaluates compliance issues/concerns within agency.? The position ensures the Board of Directors, management and employees that the agency achieves and maintains a high level of compliance with all applicable laws and regulations while supporting the growth of ACP.

This requires the individual in this position to have a working knowledge of all agency policies and procedures as well as relevant local, state and federal laws and the related requirements of licensing, accrediting and regulatory organizations such as ACQ, OIG, various insurance companies, and any other organizations determined by the Executive Leadership, including the Board for each state in which agency conducts or plans to conduct business.

Essential Functions

• Regular and reliable attendance is an essential function of this position.
• Develop, implement, and continuously review the Compliance Plan for the agency.
• ?Prepare semi-annual compliance reports for the Board describing general compliance efforts undertaken during the preceding year, identifying any changes necessary to improve the Compliance Program.
• Prepare and present quarterly reports to the Senior Leadership Team regarding matters of compliance and ongoing state of the compliance initiatives including risk areas.
• Provide compliance training to all levels of staff on a regular basis to ensure relevance and to provide guidance.
• Chair and facilitate all activities of the Compliance Committee.
• ?Develop and implement compliance monitoring plan that addresses internal review and audit of billing, health and safety, clinical record documentation, census, staffing, and other internal and external reporting requirements
• Develop, initiate, maintain, and revise policies, procedures and protocols of the agency including fiscal practices, Board of Directors, People Operations and its related activities to prevent illegal, unethical or improper conduct.
• Review and update the agency’s Code of Conduct to ensure relevance and guidance to managers and employees.
• Engage with clinical / site leaders to address events requiring compliance/regulatory input; the compliance director will need to be prepared / capable to partner and provide substantive feedback and solutions to ACP clinic teams
• Act as an independent review and evaluation body ensuring that compliance issues/concerns within the agency are being appropriately evaluated, investigated, and resolved.
• Identify potential areas of compliance vulnerability and risk, provides guidance to Senior leadership and develops and implements corrective action plans for the resolution of issues.
• Monitor compliance hot line/helpdesk and ensure that issues/concerns are evaluated, investigated and resolved.
• Implement and oversee the mechanisms for obtaining and investigating complaints.
• In coordination with the People Operations Department, overseeing and ensuring the agency’s compliance with local, state and federal regulations, such as: Office of Inspector General compliance with LEIE, SAM EPLS; Independent Contractor Agreements, etc.
• In coordination with the Director of Training and Quality Identify agency-wide, programmatic, or departmental training needs based on trends derived from monitoring activities and work with senior leadership to implement and prioritize a training plan?
• In coordination with the Finance Department and legal counsel to ensure that appropriate Business Associate Agreements are executed with vendors who have access to protected health information or personal information, including provisions to ensure that the staff of Business Associates is properly trained.
• In coordination with the Finance Department and programs to ensure compliance with the Red Flag rules.
• In coordination with the programs ensuring disclosures and/or breaches are logged and reported as per federal and state guidelines.
• Develop and implement corporate policies, procedures, forms and protocols associated with compliance.? This includes: identifying the need for new policies, procedures, forms and protocols, or the need to modify existing documents; drafting such documents for review by the Senior Leadership; coordinating as appropriate with legal counsel; and providing guidance to staff throughout the agency on the implementation of policies, procedures, forms and protocols;
• Research, monitor and communicate state and federal regulations affecting the agency’s current operations or potential expansion of operations.
• Provide support to program administration when other external audits are conducted, as requested.
• Develop positive relationships with program management while retaining independence and objectivity.
• In conjunction with other staff, performs ongoing analysis of risk and trends of incidents, investigations, allegations and/or complaints.? Identifies and recommends preventive measures or actions plans as necessary.
• Assist with investigations at the request of the CEO or COO when a conflict of interest would otherwise exist.
• Liaison with departments to conduct gap analysis and focused and comprehensive evaluations to assess system improvement needs and provide support and/or consultation as needed.
• Prepare the organization for and serve as subject matter expert on accreditation activities
• Work with Revenue Cycle and clinical leadership to overturn denials and appeals that require the compliance subject matter expert.
• Represent ACP at various conferences and state organization meetings and maintain membership at company chosen groups.
  
  

Competencies

• Highly disciplined and organized, both operationally and in thought process
• The ability to interact with staff effectively at all levels in the organization.
• Outstanding verbal and written communication skills
• Innovative, proactive, strong analytical and problem-solving skills.
• Deadline-driven mindset with excellent time management skills.
• Demonstrated ability to define & articulate business solutions to compliance issues; and to educate and achieve alignment with internal and external audiences
  
  

Salary range is $80,000- $100,000 - title and compensation will be commensurate with experience.