Director of Compliance

Bronx, NY, United States

Overview:

At Essen Health Care, we care for that!

As the largest privately held multispecialty medical group in the Bronx, we provide high-quality, compassionate, and accessible medical care to some of the most vulnerable and under-served residents of New York State. Guided by a Population Health model of care, Essen has five integrated clinical divisions offering urgent care, primary care, and specialty services, as well as nursing home staffing and care management. Founded in 1999, our over 20-year commitment has fueled an unwavering dedication toward innovating a better healthcare delivery system. Essen has expanded from a single primary care office to an umbrella organization offering specialties from womens health to endocrinology, from psychiatry to a vast array of other specialties. All clinical services are offered via telehealth or in-person at over 35 medical offices and at home through the Essen House Calls program.

Essen Health Care is the place Where Care Comes Together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ Practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today!

Job Summary:

Job Summary: The Director of Compliance will be responsible for managing and coordinating compliance processes and procedures across organizational and functional areas to promote compliance with federal, state, and local laws, rules and regulations. Working in partnership with Senior Management to develop and communicate mission and vision for compliance and to develop and implement appropriate policies, procedures and other tools to realize that vision.

Responsibilities:

Manages various compliance program activities at the direction of the CCO.

Assist in the establishment departmental goals and objectives that are consistent with, and lead to the successful achievement of, divisional and corporate goals and objectives. Achieve departmental goals and objectives by providing effective leadership, management, strategic direction, and budget and business planning.

Assist in analyzing the OIG Workplan and other relevant guidance, and develops an annual audit plan with the assistance of compliance team and the Executive Compliance Committee, to identify and prioritize compliance risks throughout the organization.

Assist in the designing, planning, and performance of compliance monitoring activities with respect to the annual audit plan. Delegates compliance responsibilities to team members, and supervises these activities to ensure proper completion and follow-up.

Documents and reports the results of the compliance activities to the CCO in a timely manner.

Investigates and prepares responses to audits performed by outside agencies, including the OCR, CMS, CMS contractors, the OIG and managed care insurance agencies.

Prepares appeals of adverse decisions resulting from external audit activities.

Provide advice and assistance to management on compliance issues and related opportunities for process improvements.

Perform internal compliance investigations and audits throughout the organization, including compiling detailed reports, making recommendations and implementing corrective to the CCO and other senior management staff actions, as appropriate.

Monitors legal and regulatory developments relating to Essen operations and advises applicable departments of same.

Maintains current knowledge of relevant regulatory guidelines, pertinent regulations, and government enforcement initiatives.

Continually assess the effectiveness of departmental functioning, including the people, processes and technologies needed to achieve departmental and corporate goals and objectives. Identify problems and opportunities for improvement and generate creative solutions that improve qualitative and quantitative performance.

Assist in the direction of the planning, design, development, implementation and evaluation of policies and procedures that assure Corporate Compliance Program activities are managed effectively.

Identify areas of potential vulnerability and risk, developing corrective action plans, and providing general guidance to address issues.

Provide oversight in the development, implementation and monitoring of the compliance program training materials, and be able to conduct compliance training, as needed.

Qualifications: At least five (5) years in the healthcare compliance industry, including previous management experience.

A minimum of two (2) years experience in medical coding and reimbursement,

auditing or healthcare clinical activities.

Full understanding of the healthcare regulatory industry, with experience in conducting complex compliance investigations.

Must have the ability to carry out non-routine procedures under constantly changing conditions.

Advanced computer skills including Microsoft Office; especially Word, Excel, and PowerPoint.

Bachelors degree or higher in business, healthcare related field.

Certification in Healthcare Compliance (CHC) or Certification in Compliance & Ethics Professional (CCEP), required

Certification in Medical Coding or Auditing: Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) or Certified Professional Medical Auditor (CPMA), preferred

Certification in Healthcare Privacy Compliance (CHPC), preferred

Certification in Healthcare Research Compliance (CHRC), preferred

Equal Opportunity Employer:

Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.