Director of Compliance
$130,000–$165,000 year
On-siteGlendale, California, United States
Glendale, California, United StatesOn-siteFull Time$130,000–$165,000 yearSenior LevelHealthcare TechMedium
Full TimeSenior LevelMediumHealthcare Tech
Job Summary
Develop and maintain the organization's Corporate Compliance Program across all physician practice locations, conducting annual risk assessments and work plans. Ensure adherence to federal, state, and local laws governing CMS, CDPH, and fraud statutes while monitoring coding, billing, and medical record documentation. Oversee oncology-specific standards for chemotherapy administration, hazardous drug handling, and infusion centers. Investigate compliance concerns, manage the anonymous reporting hotline, and coordinate internal audits. Serve as a strategic advisor to executive leadership, develop annual compliance education for clinical and revenue cycle staff, and coordinate readiness for CMS, OIG, and accreditation surveys.
Required Qualifications
- Bachelor's degree
- 8–10 years of progressive healthcare compliance experience
- At least 5 years in physician practice compliance
- Multi-site healthcare organization experience
- Experience with Medicare and Medi-Cal regulations
- Experience managing compliance investigations and audits
- Extensive knowledge of physician practice regulations
- Oncology regulatory expertise
- Medicare and Medi-Cal billing compliance
- HIPAA Privacy and Security
- Fraud, Waste, and Abuse regulations
- Stark Law and Anti-Kickback Statute
- Healthcare auditing methodologies
- Risk assessment and mitigation
- Policy development
- Strong leadership, communication, and project management skills
Desired Qualifications
- Master's degree in Healthcare Administration, Business Administration, Public Health, Nursing, Law, or related field
- Oncology experience
- Certified in Healthcare Compliance (CHC)
- Certified in Healthcare Privacy Compliance (CHPC)
- Certified Professional Coder (CPC)
- Registered Health Information Administrator (RHIA)
- Experience with Centers for Medicare & Medicaid Services (CMS)
- California Department of Public Health (CDPH)
- California Medical Board requirements
- California Department of Health Care Services (DHCS)
- Office of Inspector General (OIG)
- Department of Justice (DOJ)
- HIPAA Privacy and Security Rules
- OSHA
- California labor regulations affecting healthcare operations
- Federal and California Fraud, Waste, and Abuse laws
- False Claims Act
- Anti-Kickback Statute
- Stark Law
- Medicare and Medi-Cal regulations
- Physician Practice Compliance
- Monitor compliance across multiple satellite physician offices
- Ensure provider credentialing and licensure compliance
- Oversee medical record documentation compliance
- Evaluate coding and billing practices
- Monitor incident-to billing requirements
- Oversee provider enrollment compliance
- Coordinate internal compliance audits
- Monitor chemotherapy and biologic administration compliance
- Ensure compliance with infusion center standards
- Oversee hazardous drug handling standards
- Monitor oral oncology dispensing compliance
- Ensure compliance with prior authorization requirements
- Support oncology quality initiatives
- Assist with accreditation readiness
- Serve as Privacy Officer or collaborate closely with the Privacy Officer
- Investigate privacy incidents and breaches
- Oversee HIPAA training
- Conduct HIPAA risk assessments
- Ensure Business Associate Agreements are maintained
- Develop and oversee audits including Medical record documentation
- Evaluation & Management coding
- Chemotherapy administration documentation
- Infusion billing Modifier usage
- Incident-to billing
- Medical necessity
- Clinical documentation integrity
- Provider documentation
- Laboratory compliance
- Pharmacy compliance
- Investigate compliance concerns
- Manage anonymous reporting hotline
- Conduct internal investigations
- Recommend corrective actions
- Monitor corrective action plans
- Develop annual compliance education for Physicians
- Advanced Practice Providers
- Nurses
- Medical Assistants
- Clinical Research staff
- Revenue Cycle
- Front Office staff
- Leadership
- Policies and Procedures
- Develop and revise compliance-related policies
- Ensure policies remain current with changing regulations
- Standardize compliance practices across all satellite offices
- Perform compliance risk assessments
- Identify emerging regulatory risks
- Develop mitigation strategies
- Monitor corrective actions
- Coordinate readiness for organizations such as Accreditation surveys
- State inspections
- CMS audits
- OIG audits
- Commercial payer audits
- Collaborate with Revenue Cycle to monitor Coding accuracy
- Charge capture
- Billing compliance
- Refunds and overpayments
- Credit balance management
- Denials related to compliance
- Ensure compliance with research regulations
- Monitor informed consent requirements
- Coordinate with Institutional Review Boards (IRBs)
- Support Good Clinical Practice (GCP) standards
- Monitor specialty pharmacy regulations
- Ensure compliance with drug storage requirements
- Oversee controlled substance policies
- Monitor drug diversion prevention
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