Director of Compliance

JOB TITLE: Director of Compliance 
FLSA STATUS (Exempt/Non-Exempt): Exempt 
SUPERVISION RECEIVED: Reports to Chief Executive Officer 
SUPERVISION EXERCISED: Compliance Staff, as applicable 

GENERAL STATEMENT OF DUTIES 

Responsible for developing, implementing, overseeing, and continuously evaluating Premier and Philadelphia Hand to Shoulder Center compliance program to promote adherence to applicable federal and state laws, regulations, organizational policies, and healthcare industry standards. Provides leadership and guidance regarding regulatory compliance, HIPAA and patient privacy, OSHA and workplace safety compliance, compliance investigations, auditing and monitoring, education and training, and corrective action activities. Conducts routine compliance site visits and assessments across all locations to identify potential compliance and safety concerns and partners with Operations, Human Resources and other departments to ensure identified issues are appropriately addressed and remediated. 

ESSENTIAL FUNCTIONS 

• Develops, implements, maintains, and oversees Premier and Philadelphia Hand to Shoulder Center compliance program, policies, procedures, and related initiatives.  

• Serves as a primary compliance resource to organizational leadership, physicians/providers, managers, and staff.  

• Monitors applicable federal and state healthcare laws, regulations, and regulatory guidance and assists the organization in implementing necessary changes.  

• Develops and maintains an annual compliance work plan based on organizational risks, regulatory requirements, audit findings, and identified trends.  

• Conducts routine compliance site visits and audits across all locations to evaluate adherence to organizational policies and applicable regulatory requirements.  

• Develops standardized site compliance audit tools and maintains documentation of site visits, findings, corrective actions, and follow-up activities.  

• Oversees organizational OSHA compliance activities and works with operational leadership to promote safe and compliant workplace practices.  

• Conducts and/or coordinates OSHA-related site assessments and monitors compliance with applicable workplace safety requirements, including required postings, safety documentation, training, exposure control practices, and other applicable standards.  

• Partners with Operations and site leadership to identify and correct workplace safety and regulatory deficiencies.  

• Develops corrective action plans for identified compliance deficiencies and monitors completion to ensure appropriate remediation.  

• Oversees HIPAA privacy compliance and provides guidance regarding patient privacy, confidentiality, appropriate access, and disclosure of protected health information.  

• Investigates reported or suspected HIPAA/privacy incidents and coordinates appropriate response, documentation, mitigation, and escalation.  

• Receives, reviews, and investigates compliance concerns reported by employees.  

• Maintains appropriate mechanisms for employees and other individuals to report compliance concerns without fear of retaliation.  

• Conducts or coordinates internal compliance investigations, including gathering documentation, interviewing appropriate individuals, documenting findings, and making recommendations to leadership.  

• Partners with Human Resources on investigations involving compliance concerns.  

• Oversees compliance auditing and monitoring activities and identifies trends, areas of risk, and opportunities for improvement.  

• Partners with Revenue Cycle Management and applicable departments regarding billing, coding, documentation, and reimbursement compliance concerns.  

• Coordinates or assists with internal and external compliance audits and regulatory reviews.  

• Responds to compliance-related requests for information from regulatory agencies, auditors, payers, and other external entities in coordination with appropriate leadership and legal counsel.  

• Develops, implements, and maintains required compliance education and training programs for employees, managers, and physicians/providers.  

• Ensures required compliance training is completed within established timeframes and maintains appropriate documentation.  

• Provides education and guidance regarding the organization's Code of Conduct, compliance policies, HIPAA/privacy requirements, fraud, waste and abuse, OSHA requirements, and other applicable compliance topics.  

• Oversees monitoring of applicable federal and state exclusion and sanction requirements in coordination with appropriate departments.  

• Reviews organizational policies and procedures for compliance with applicable laws, regulations, and organizational standards.  

• Partners with department leaders to develop or revise policies when regulatory or operational changes occur.  

• Tracks compliance incidents, investigations, audit findings, site visit findings, corrective actions, and other compliance activities.  

• Analyzes compliance trends and prepares reports for senior leadership and applicable committees.  

• Escalates significant compliance concerns, regulatory risks, or repeated deficiencies to appropriate leadership.  

• Participates in compliance committees and other organizational committees as requested.  

• Promotes a culture of compliance, accountability, patient privacy, workplace safety, and ethical conduct throughout the organization.  

• Maintains strict confidentiality of compliance investigations, employee information, patient information, and other sensitive organizational information.  

• Performs other duties as assigned.  

EDUCATION 

• Bachelor's degree in Healthcare Administration, Business Administration, Health Information Management, Nursing, Compliance, or a related field required.  

• Master's degree in Healthcare Administration, Business Administration, Compliance, or a related field preferred.  

• Healthcare compliance certification such as Certified in Healthcare Compliance (CHC) preferred.  

EXPERIENCE 

• Minimum of five (5) years of progressively responsible experience in healthcare compliance, regulatory compliance, healthcare operations, risk management, or a related field.  

• Prior leadership or management experience preferred.  

• Experience conducting healthcare compliance audits, investigations, and/or site assessments required.  

• Experience with HIPAA/privacy compliance and healthcare regulatory requirements required.  

• Experience with OSHA and workplace safety compliance in a healthcare environment preferred.  

• Experience working in a multi-site physician practice, medical group, or outpatient healthcare organization strongly preferred.  

• Experience collaborating with physicians/providers, operational leadership, Human Resources, Revenue Cycle Management, and legal counsel preferred.  

KNOWLEDGE 

• Knowledge of healthcare compliance principles and compliance program requirements.  

• Knowledge of applicable federal and state healthcare laws and regulations.  

• Knowledge of HIPAA Privacy and Security requirements and patient confidentiality standards.  

• Knowledge of OSHA requirements applicable to physician practices and outpatient healthcare environments.  

• Knowledge of healthcare fraud, waste, and abuse requirements.  

• Knowledge of healthcare billing, coding, documentation, and reimbursement compliance principles.  

• Knowledge of compliance auditing, monitoring, investigation, and corrective action processes.  

• Knowledge of healthcare regulatory agencies and applicable reporting requirements.  

• Knowledge of compliance education and training requirements.  

• Knowledge of Microsoft Office applications and compliance tracking and reporting systems.  

SKILLS 

• Strong leadership and compliance program management skills.  

• Excellent verbal and written communication skills.  

• Strong investigative, auditing, and analytical skills.  

• Skill in conducting compliance site visits and identifying regulatory and operational risks.  

• Skill in interpreting and applying healthcare regulations and organizational policies.  

• Skill in conducting sensitive and confidential investigations.  

• Skill in developing corrective action plans and monitoring remediation.  

• Skill in developing and delivering compliance education and training.  

• Skill in preparing professional reports, investigation summaries, audit findings, and recommendations.  

• Strong organizational, prioritization, and time-management skills.  

• Strong problem-solving and critical-thinking skills.  

• Skill in establishing effective working relationships with physicians/providers, leadership, managers, employees, and external stakeholders.  

• Skill in maintaining professionalism, objectivity, discretion, and confidentiality.  

ABILITIES 

• Ability to independently oversee and manage the organization's compliance program.  

• Ability to conduct objective compliance investigations, audits, and site assessments.  

• Ability to identify potential regulatory and compliance risks and recommend appropriate corrective actions.  

• Ability to interpret complex regulatory requirements and translate them into practical operational processes.  

• Ability to communicate compliance expectations effectively to physicians/providers, leadership, managers, and staff.  

• Ability to exercise independent judgment and appropriately escalate significant compliance concerns.  

• Ability to manage multiple investigations, audits, projects, and regulatory deadlines simultaneously.  

• Ability to collaborate effectively across departments while maintaining appropriate independence and objectivity of the compliance function.  

• Ability to handle sensitive and confidential information with discretion.  

• Ability to travel routinely between office locations to conduct site visits, audits, education, and follow-up activities.  

ENVIRONMENTAL WORKING CONDITIONS 

• Normal office and outpatient clinical environment.  

• Regular travel between office locations to conduct compliance and OSHA site visits, audits, investigations, and education.  

• May occasionally encounter clinical environments where bloodborne pathogen, hazardous material, or other workplace safety requirements apply.  

PHYSICAL/MENTAL DEMANDS 

• Requires sitting, standing, walking, and occasional bending associated with office and clinical environments.  

• Requires manual dexterity for computer and telephone use.  

• Requires the ability to travel between and walk through clinical and administrative locations when conducting site assessments.  

• Requires sustained attention to detail and the ability to analyze complex regulatory and compliance matters.  

• Requires the ability to manage sensitive investigations and difficult situations with professionalism, objectivity, discretion, and sound judgment.  

ORGANIZATIONAL REQUIREMENTS 

• HOPCo's Mission, Vision, and Values must be acknowledged and adhered to.  

• Completes all required organizational compliance, privacy, safety, and other training.  

• Maintains compliance with all policies and procedures.