Job Summary
Position Title: Director of Compliance
Position Summary: Reporting to and working under the direction of the Chief Compliance Officer, the Compliance Director is responsible for developing, implementing, maintaining, and enforcing key components of Essen's Compliance Program. The role promotes compliance with applicable federal, state, and local laws and regulations, including Medicare, Medicaid, and HIPAA requirements. The Compliance Director serves as a strategic leader and subject matter expert, partnering with operational and clinical leadership to strengthen regulatory compliance, mitigate organizational risk, facilitate audit readiness, and foster a culture of ethics and accountability.
Responsibilities
Key Responsibilities
- Develops, implements, and coordinates with internal stakeholders, including others in Compliance, program-specific workplans reflecting current external and internal compliance risks within assigned area of responsibility.
- Facilitates internal and external compliance, regulatory, and payer audits by coordinating documentation, stakeholder engagement, audit responses, and follow-up activities.
- Coordinates organizational audit readiness efforts and assist departments in preparing for regulatory reviews, payer audits, and accreditation surveys.
- Identifies compliance trends, emerging risks, and opportunities for process improvement through monitoring, data analysis, and collaboration with operational teams.
- Partners with Compliance, Clinical Operations, Revenue Cycle Management, Provider Education, Information Technology, and other departments to support enterprise compliance initiatives.
- Develops and deliver compliance education to providers on regulatory requirements, documentation standards, and organizational policies.
- Monitors changes in federal and state healthcare regulations and communicate impacts and recommended actions to operational teams.
- Coordinates corrective action plans resulting from audits, investigations, monitoring activities, or regulatory reviews, and monitor remediation efforts through completion.
- Prepares reports, dashboards, and executive summaries that communicate compliance program performance, risk trends, key metrics, and organizational priorities to executive leadership and compliance committees.
- Supports organizational oversight activities related to Fraud, Waste, and Abuse (FWA), documentation integrity, privacy, and regulatory compliance.
- Serves as a compliance resource and advisor to leadership on regulatory requirements, policy interpretation, and compliance best practices.
- Promote continuous improvement of compliance processes, governance, and internal controls across the organization.
Qualifications
Required Qualifications
- Minimum of 7–10 years of progressive experience in healthcare compliance within a hospital, physician group, managed care organization, health plan, or payer environment.
- Strong knowledge of CMS regulations, Medicare Advantage, New York State Medicaid, HIPAA, and other applicable healthcare regulations.
- Demonstrated experience supporting regulatory audits, compliance monitoring activities, corrective action planning, and organizational audit readiness.
- Strong analytical, communication, project management, and leadership skills.
- Proficiency with electronic health record (EHR) systems and Microsoft Office Suite.
Preferred Qualifications
- Experience supporting delegated vendor oversight, government program compliance, and regulatory examinations.
- Bachelor's degree in Health Information Management, Healthcare Administration, Public Health, Healthcare Law, Nursing, or a related field preferred.
Core Competencies
- Healthcare Regulatory Compliance
- Compliance Program Administration
- Regulatory & Audit Readiness
- Risk Assessment & Mitigation
- Compliance Monitoring
- Policy Development & Governance
- Cross-Functional Leadership
- Provider & Staff Education
- Data Analysis & Executive Reporting
- Strategic Problem Solving
Work Environment
- Onsite - Bronx, New York Office Monday - Friday
