Director, Compliance (MediGold)

Mount Carmel East Hospital   •  

Columbus, OH

Industry: Healthcare


5 - 7 years

Posted 218 days ago

  by    Adam Miller

This job is no longer available.

At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We?re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

The Director, Compliance is responsible for overseeing and implementing the organization's compliance program, compliance audits, training, and policies, delegation oversight, and CMSaudits, and for supporting HIPAA privacy functions in accordance with Medicare Advantage regulations and the Compliance Program Guidance issued by the Office of the Inspector General. In collaboration with the Vice President, Compliance and Governance and Chief Compliance Officer, the Director, Compliance provides oversight and implements the health plan's compliance program, compliance audits, training, and policies, delegation oversight, and CMSaudits, and supports HIPAA privacy functions through the identification and documentation of compliance risks, including responding to issues of non-compliance, and by overseeing corrective action plans to ensure compliance with regulatory requirements.


  • Provides leadership oversight for federal and state regulatory operational compliance of the auditing and training program specific to the health plan, contracted providers and delegated vendors.
  • Completes regulatory compliance audits internally and externally to ensure compliance with the organization's plans, policies and procedures and applicable federal and state regulations, including the identification of risk areas for fraud and abuse.
  • Directs the preparation of audit finding reports and recommendations for stakeholders.
  • Assists with preparation and submission of required government program filings with federal (CMS) and state regulatory agencies (ODI, ODH).
  • Develops and implements training and communication strategies to ensure health plan departments' compliance with current and proposed laws, regulations and guidelines. Prepares presentations, in-services, training materials, manuals, audit tools and reports.
  • Evaluate the effectiveness of corrective action plans; assists with the preparation and submission of corrective action plans.
  • Provides oversight and direction to Compliance department in organizing and directing day-to-day operations of the department.
  • Uses principles of change management to facilitate organizational improvements.
  • Implements and manages intradepartmental policies and procedures. Provides guidance to interdepartmental policies and procedures as compliance subject matter expert.
  • Actively participates in Health Plan and/or System wide committees as required.
  • Identifies and evaluates compliance issues in the organization and collaborates with other departments to direct issues to appropriate channels for investigation and resolution.
  • Conducts periodic risk assessments and mock audits.
  • Serves as an internal resource for all departments to address compliance-related questions or concerns and to advise colleagues on compliance and regulatory matters.
  • Managing and growing the compliance department colleagues.
  • Oversee operationalization of CMS, ODI, and other government and regulatory requirements impacting operations
  • All other duties as assigned.


  • Education: Bachelor's degree in health care, business administration or related field.
  • Licensure / Certification: Certification in Healthcare Compliance preferred.
  • Experience: Minimum of five (5) years of experience performing compliance and internal auditing, preferably for a Medicare Advantage Plan or other government programs health insurer; Previous management experiencerequired.
  • Strong working knowledge of Ohio and federal laws, regulations and guidelines governing health plans, Medicare Advantage plans and the Medicare-fee-for service program.
  • Effective Communication Skills; demonstrated ability to communicate with internal and external partners with all levels of authority within an organization.
  • Ability to prioritize and manage high volume tasks and responsibilities simultaneously.
  • Demonstrated ability to partner effectively with others in handling complex issues.
  • Maintain knowledge of current and proposed laws, regulations, guidelines and industry trends within Medicare managed care industry.
  • Demonstrated ability to evaluate the effectiveness of correction action plans, principles and designs.
  • Works independently and requires high level of judgment and discretion.
  • Demonstrates high tolerance for ambiguity and change while providing leadership to department staff and others to adapt effectively to meet changing environment.

Discovering opportunities, support and excellence ? all while making a real difference in patients? lives ? begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.