Associate Director, Compliance Initiatives

About the role

The Associate Director leads the resolution of complex compliance issues by conducting thorough analysis, research, documentation, and reporting, while collaborating with relevant stakeholders to ensure the Office of Institutional Compliance receives accurate and actionable information to support timely, well-informed decisions that advance organizational compliance objectives.

Primary Location: United States-Texas-Galveston; Work Location: 0124 - Administration Bldg.

Responsibilities

• INVESTIGATIONS/AUDITS: Partners with Compliance Attorneys and/or other management teams throughout the institution to research deficiencies, conduct investigations, and develop post-review memorandums, which include guidance and recommendations for issues related to HIPAA violations, conflicts of interest (COI), patient and employee hotline allegations, billing disputes and others compliance related concerns. Performs, or assists in the performance of, special reviews or investigations at the request of management. Serves as project lead for external reviews performed by regulatory agencies and non-regulatory agencies (such as consulting firms). Updates the investigation and audit tracking databases, as necessary. Works closely with Revenue Cycle Operations, Medical Records, and other departments to ensure that records requests and appeals are timely submitted for various auditing bodies such as Medicare, Medicaid, RACs, HRSA, MSP, ADR, CERT, SMRC, OIG (federal and state), etc. Develops various auditing workflows by payor, which identify the department(s) that is/are responsible for each step in the process.
• COMPLIANCE LIAISON: Works in close collaboration with other Compliance staff and/or other management teams throughout the institution to ensure program-wide compliance efforts are in alignment with the Centers for Medicare & Medicaid Services (CMS),