Director of Compliance

POSITION SUMMARY

The Director of Compliance serves as the operational leader of the organization’s Compliance Program under the direction of the Chief Compliance Officer (CCO). The Director is responsible for translating the CCO’s compliance strategy and priorities into effective day-to-day program operations, including risk assessment, monitoring and auditing, investigations, corrective action, policy administration, education, regulatory readiness, clinical compliance oversight, and assigned enterprise risk and corporate regulatory administration. The Director functions as a key advisor and operational partner to the CCO and helps ensure that compliance and risk activities are coordinated, documented, risk-based, and effective. The Director position will be based in the Phoenix, AZ office and be a hybrid remote/office based position.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Manage the day-to-day operation and administration of the organization’s Compliance Program in alignment with the direction and priorities established by the CCO.
• Coordinate implementation of the annual compliance work plan and track completion of compliance initiatives, deliverables, and corrective actions.
• Promote effective communication and coordination among Compliance, Clinical, Operations, Revenue Cycle, Human Resources, Legal, and other business functions.
• Promote effective communication and coordination among Compliance, Clinical, Operations, Revenue Cycle, Human Resources, Legal, Finance, Information Technology, and other business functions.
• Maintain appropriate documentation demonstrating the organization’s compliance program activities and effectiveness.

• Support and coordinate the organization’s periodic compliance risk assessment process.
• Identify emerging compliance risks through regulatory developments, audit findings, hotline activity, investigations, operational trends, and other relevant sources.
• Assist the CCO in developing, implementing, and monitoring the annual compliance work plan.
• Recommend risk-based monitoring, auditing, education, and corrective action activities.

• Oversee routine compliance monitoring and auditing activities, including clinical, coding, billing, documentation, and operational compliance reviews.
• Coordinate audit methodology, sampling, documentation, findings, management responses, and follow-up.
• Identify patterns, trends, and potential systemic concerns and promptly escalate significant findings to the CCO.
• Track corrective action plans and validate completion and effectiveness when appropriate.

• Manage or support compliance investigations involving suspected violations of law, regulation, policy, billing requirements, or the organization’s standards of conduct.
• Ensure investigations are appropriately documented, objective, timely, and escalated based on risk and significance.
• Partner with the CCO, Outside Legal Counsel, Professional Employment Organization, Human Resources, Operational Leadership, Clinical Leadership, and other stakeholders as appropriate.
• Coordinate corrective and preventive actions arising from investigations, audits, disclosures, complaints, or regulatory findings.
• Immediately escalate significant legal, regulatory, patient safety, financial, retaliation, or False Claims Act concerns to the CCO.

• Coordinate development, review, implementation, and maintenance of compliance policies and procedures.
• Oversee or support compliance education and training, including general compliance education and targeted training addressing identified risks.
• Monitor relevant federal and state regulatory developments and assist operational leaders in evaluating implementation requirements.
• Support preparation for payer, governmental, accreditation, or other external compliance reviews.

• Provide leadership and oversight to the Clinical Compliance Manager and clinical compliance activities.
• Coordinate monitoring of documentation, coding, billing, medical necessity, clinical protocols, and other identified clinical compliance risks.
• Partner with clinical leadership to develop practical, compliant guidance and education for providers and clinical teams.
• Ensure clinical compliance findings and trends are appropriately communicated, remediated, and escalated.

• Coordinate corporate regulatory administration activities, including annual legal entity filings and reports, business licenses, permits, mobile permits, and other state or local registration requirements, in coordination with Legal, Finance, Operations, and other responsible departments.
• Coordinate compliance and regulatory activities associated with entry into new states and markets, including identification and tracking of required licenses, permits, registrations, and related compliance requirements.
• Coordinate the organization’s corporate insurance and risk-management administration, including certificates of insurance for provider recruiting, MOUs, and other business needs; annual insurance renewals; and communication with brokers, carriers, Legal, Clinical, IT, Operations, and other stakeholders.
• Maintain or coordinate the dentist master roster and other compliance-related organizational or provider records needed to support insurance, licensing, credentialing, and regulatory requirements.
• Coordinate enterprise risk-control activities, including periodic risk-control reviews, IT risk-control meetings, identified control changes, and related policy updates.
• Coordinate fleet and risk compliance activities, including claims administration and follow-up with appropriate internal and external parties.
• Coordinate with departments across the organization regarding identified risks, controls, operational changes, and policies, and escalate material enterprise risks to the CCO.
• Coordinate with outside counsel regarding routine intellectual property administration and maintenance, as assigned by the CCO.
• Coordinate maintenance of required in-state corporate addresses and related renewals or administrative requirements, while routine mail-forwarding or clerical functions may be performed by designated administrative staff.

• Prepare compliance reports, dashboards, metrics, trend analyses, and other materials for review by the CCO.
• Support CCO reporting to executive leadership, the Compliance Committee, and the Board or appropriate Board committee.
• Supervise, coach, and develop assigned Compliance staff and establish clear performance expectations.
• Serve as the CCO’s operational delegate for routine compliance and assigned enterprise risk matters while recognizing that significant compliance decisions, enterprise risk determinations, and Board-level matters remain under the authority of the CCO.

MINIMUM QUALIFICATIONS

• Bachelor’s degree in healthcare administration, business, legal studies, compliance, clinical discipline, or a related field; advanced degree preferred.
• Progressive experience in healthcare compliance, regulatory compliance, auditing, investigations, revenue cycle compliance, enterprise risk, corporate regulatory administration, or a related field.
• Demonstrated knowledge of healthcare compliance program principles and applicable federal and state healthcare regulatory requirements.
• Experience managing compliance projects, investigations, audits, corrective actions, regulatory requirements, and cross-functional initiatives.
• Prior supervisory or leadership experience preferred.

PREFERRED CREDENTIALS

• Certified in Healthcare Compliance (CHC) strongly preferred.
• Additional relevant credentials such as CHPC, CHRC, CPC, CCS, CPA, CIA, or similar certification are beneficial depending on experience and responsibilities.

KNOWLEDGE, SKILLS AND ABILITIES

• Strong knowledge of effective healthcare compliance program practices and risk-based compliance oversight.
• Ability to independently analyze complex regulatory, operational, clinical, and billing issues and clearly communicate findings.
• Strong investigation, auditing, documentation, project management, and problem-solving skills.
• Sound judgment and the ability to recognize matters requiring prompt escalation to the CCO or Legal Counsel.
• Ability to build effective working relationships while maintaining the independence and objectivity required of the Compliance function.
• Strong written and verbal communication skills, including the ability to communicate effectively with executives, clinicians, operational leaders, and staff.
• High degree of integrity, discretion, professionalism, and commitment to confidentiality and non-retaliation principles.