Compliance Investigator

Acadia Healthcare · Franklin, TN · Yesterday

Full-time

About the role

The Compliance Investigator is responsible for conducting and overseeing prompt, thorough, and objective investigations of alleged or suspected violations of law, regulation, Acadia policy, and ethical standards across Acadia’s facilities. This role manages investigations of high impact and complexity while relating to patients and colleagues with empathy and compassion. The position supports the effectiveness of the company’s Compliance Program by ensuring concerns are appropriately triaged, investigated, documented, concluded, and resolved in accordance with company policy and procedure as well as federal and state requirements.

The Compliance Investigator partners closely with Legal, Human Resources, Clinical, and Operational leadership to drive standardization of the investigative process, assess risk, support and track corrective action(s), and promote a culture of accountability, integrity, and patient safety. The role requires the ability to handle sensitive matters with discretion, maintain independence and objectivity, and apply sound judgment in complex and high-risk situations.

Responsibilities

Lead Compliance Investigations: Conduct timely, thorough, and objective investigations involving healthcare regulatory compliance, billing and coding concerns, fraud waste and abuse risks, HIPAA privacy and security matters, workplace misconduct affecting compliance or patient care, and patient safety and quality-of-care concerns. Develop investigation plans, define scope, identify key risks, and execute investigative strategies. Conduct interviews; collect, review, and analyze documentation, records, data, communications, and other evidence; identify root causes, control gaps, and opportunities for risk mitigation.
Manage Intake, Triage, and Case Resolution: Assess reports received through reporting hotlines, employees, audits, vendors, and other channels. Perform risk-based triage and prioritization of compliance concerns. Maintain accurate and complete case documentation throughout the investigative process. Ensure investigations are conducted consistently and in accordance with company policies and regulatory requirements.
Drive Corrective Actions and Reporting: Translate complex findings into clear, concise, and actionable investigative reports. Present conclusions and recommendations to Compliance and business leaders. Partner with operational teams to develop, monitor, and validate corrective action plans. Escalate significant compliance, legal, regulatory, or patient safety risks as appropriate. Maintain documentation that meets legal, audit, and compliance standards.
Partner Across the Organization: Collaborate with Legal, Human Resources, Quality, Clinical Operations, Internal Audit, and facility leadership. Support the continued evolution and standardization of Acadia's investigation processes. Promote a culture of ethics, compliance, accountability, and patient-centered decision making. Support organizational efforts to maintain the highest standards of integrity and regulatory compliance.

Requirements

Bachelor's degree in Healthcare Administration, Business, Legal Studies, or a related field.
3+ years of experience in healthcare compliance, investigations, healthcare operations, risk management, auditing, or a related discipline.
Working knowledge of healthcare laws and regulations, including HIPAA Privacy and Security requirements, Stark Law, Anti-Kickback Statute, OIG and DOJ compliance guidance, and federal and state healthcare program requirements.
Strong investigative, analytical, and critical thinking skills.
Excellent written and verbal communication skills, including the ability to prepare professional investigative reports.
Demonstrated ability to manage multiple priorities in a fast-paced environment.
Proficiency with Microsoft Office applications and case management systems.
Ability to work independently, exercise sound judgment, and manage highly sensitive information with discretion.
Ability to travel up to 25%.

Preferred Qualifications

5+ years of healthcare compliance or investigative experience.
Experience in behavioral health or substance use disorder treatment settings.
Experience conducting complex, enterprise-wide investigations.
Familiarity with compliance case management and incident reporting systems.
Professional certification such as Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), or Certified Fraud Examiner (CFE).

Benefits