Job Description

Position Purpose: The Compliance Director, SIU, is responsible for leading the compliance investigations program and for improving the program on a continuous basis. This position gathers, reviews, and analyzes facts, information, and other relevant information and materials relating to actual or potential problems or concerns. This position conducts specialized compliance activities designed for detection, prevention, and correction of perceived or actual noncompliance. Investigation activity includes interviews, root cause analysis, findings report writing, recommendations for follow-up and remediation activities, and corrective action plan and resolution planning development. The position also oversees and/or assists with auditing, monitoring, training, and other activities as assigned to administer the compliance, privacy, and anti-fraud, waste, and abuse (FWA) program. Key activities include:

  • Supervising a team responsible for triaging and conducting investigations into internal reports of alleged compliance, privacy, and FWA violations
  • Collaborating with departments and all levels of staff throughout the organization to facilitate a partnering-based approach to investigations and the investigation process
  • Ensuring investigative protocols, tools, and templates are established and maintained
  • Developing and executing all phases of a plan of investigation, including fact gathering; review and analysis of organizational data, information, and records; conducting interviews; and drafting findings, conclusions, and recommendations
  • Documenting processes deployed to collect documents and conduct other fact-finding activities
  • Developing, executing, and managing detailed investigation project and work plans, schedules, and status reports
  • Retaining detailed and appropriately annotated record of each investigation request and all related activity, including those matters that are investigated and found to be correct or otherwise compliant
  • Preparing summary reports on investigation trends and statistics for internal tracking and presentation to cross-functional teams, management stakeholders, and compliance committees to drive program improvements and organizational understanding of compliance risks
  • Ensuring investigative results and corrective action plans are easily understandable to auditors, regulators, and others as appropriate
  • Monitoring and confirming timely referrals of suspected FWA to appropriate agencies
  • Chairing committee and workgroup meetings to review investigative referrals, findings, and recommendations
  • Recommending change to processes and compliance program and other activities, if necessary, to prevent recurrence of any identified issues
  • Overseeing delivery of a comprehensive investigator orientation and ongoing FWA training program for Steward Health Care Network (SHCN) employees. Directing staff in managing workload, assigning tasks, monitoring progress against work plans and meeting regulatory timelines, and bringing forth issues as necessary
  • Managing and monitoring work and performance of applicable vendor(s)
  • Serving as backup point person for Vice President, Compliance and Privacy Officer and/or designated Compliance Officer for communications from State or Federal FWA entities such as the Arizona OIG, Utah OIG, and MEDIC
  • Participating in regulatory meetings and webinars and leading action needed in response to sessions
  • Minimal travel (5-10%)

Education:

  • Bachelor’s degree in a related field (health services administration, business administration, political science, criminal justice, law enforcement)
  • Clinical training (medical assistant, nursing) preferred
  • Master’s degree preferred

Years of Experience:

  • 3+ years managerial experience directly managing people and/or leadership experience leading teams, projects, programs, or directing the allocation of resources
  • 5+ years applicable health care compliance, investigative, or analyst or equivalent experience required
  • Experience conducting internal investigations in the health care industry
  • Certified in Healthcare Compliance (CHC) and/or Certified in Healthcare Privacy Compliance (CHPC) preferred
  • Other certifications a plus: Accredited Healthcare Fraud Investigator (AHFI); Certified Fraud Examiner (CFE); medical coding [Certified Coding Specialist (CCS), Certified Professional Coder (CPC)]; or Certified Fraud Specialist (CFS).

Specialized Knowledge:

  • Knowledge of healthcare regulatory environment and skills in researching state and federal laws, rules, and regulations
  • Excellent analytic and problem-solving skills
  • Excellent interpersonal, collaboration, communication and presentation skills essential
  • Familiarity with medical terminology
  • Familiarity with prescription drugs

Application Instructions

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