We are looking for a Compliance Director with at least twelve years’ prior experience working in a leadership role in the health care industry, and strong familiarity with regulatory laws and compliance, including fraud, waste and abuse. Our Compliance Director will report directly to Aledade’s Vice President - Compliance and be responsible for assisting and participating in the implementation and operation of Aledade’s Compliance program.
We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely/work from home within the US or from our HQ office in Bethesda, MD (post covid), primarily supporting east coast normal business hours.
Key Responsibilities Include:
Serving as a compliance subject matter expert and resource for employees and ACOs, enforcing compliance and the company Code of Conduct across the organization
Developing and directing internal compliance initiatives, audit and monitoring activities (e.g., risk assessment, audit work plan development and execution, audit readiness activities, etc.), including development of the annual compliance work plan in alignment with business objectives
Directing compliance reporting efforts across multiple business functions by overseeing the evaluation and summary of compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to senior management
Directing compliance investigations across multiple business functions by overseeing the collection and analysis of quantitative and qualitative data; conducting interviews on escalated issues as appropriate; reviewing and evaluating research on key business issues; and evaluating and recommending corrective action plans for substantiated allegations
Directing programs or compliance components of larger cross-functional programs, such as ACO, Medicare, commercial and Medicaid programs, by identifying and managing stakeholder contacts; developing, analyzing, and managing program plans
Directing and overseeing the implementation of compliance efforts by approving compliance requirements; ensuring the assessment of current state compliance to identify gaps and corrective actions; overseeing the analysis and development of complex compliance standards, policies and procedures, and training; and ensuring the monitoring of ongoing compliance adherence
Developing and supporting compliance training for Aledade personnel and ACO participants
Providing support for Aledade enterprise-wide initiatives, including reviewing proposed business arrangements for possible false claims, Anti-kickback, inducement and other concerns.
Providing leadership and direction to ensure alignment between key business functions and Compliance deliverables
Building, developing, and maintaining strong business relationships with colleagues on the Compliance Team, Legal Team, and business partners. Qualifications:
Minimum twelve (12) years’ experience in health care compliance, with significant experience leading compliance-related programs
Certification in HealthCare Compliance (CHC)
Juris Doctorate, with focus on health care law, desirable
Substantive knowledge of compliance requirements related to Accountable Care Organizations, Medicare programs (MSSP, Medicare Advantage, REACH, e.g.), and commercial and Medicaid programs
Familiarity with risk adjustment regulations and policies, including HCC/diagnosis code accuracy, diagnosis code submission, and Risk Adjustment Data Validation (RADV) Audit
Strong written, communication, and research skills
Interacts with others in a positive, respectful, and considerate manner. Ability to communicate effectively and professionally. Ability to work in a team environment while also delivering independent results
Demonstrated ability to work under competing deadlines and adjust responsibilities in response to recalibrated business needs
Ability to be flexible and scale with our extremely fast-paced, thriving startup environment
Thinks beyond their immediate team and contributes to making Aledade holistically better (active engagement in D&I efforts, culture initiatives, facilitating training, leading roundtables, etc.)
