The Director of Regulatory Compliance is responsible for the operational oversight and execution of the organization's compliance, regulatory, audit, and monitoring activities across the Managed Long Term Care (MLTC), Medicare Advantage Dual Eligible Special Needs Plan (MAPD/D-SNP), Certified Home Health Agency (CHHA), Licensed Home Care Services Agency (LHCSA), Article 28 Clinic and other lines of business as applicable.
This position supports the Chief Compliance Officer in maintaining an effective compliance program focused on regulatory readiness, operational compliance oversight, internal auditing and monitoring, corrective action implementation, and risk mitigation. The Director of Regulatory Compliance works collaboratively with operational leadership to ensure ongoing adherence to CMS, NYS Department of Health, Medicare, Medicaid, HIPAA, and other applicable regulatory and contractual requirements.
Performance Responsibilities and Standards: - Oversees day-to-day compliance operations and regulatory oversight activities for MLTC, MAPD/D-SNP, CHHA, LHCSA, Article 28 Clinic programs and other lines of business as applicable.
- Directs operational compliance auditing and monitoring activities to evaluate adherence to federal and state regulations, contractual obligations, internal policies, and accreditation standards.
- Develops and maintains annual compliance work plans, audit schedules, and monitoring activities based on organizational risk assessments.
- Coordinates and oversees regulatory audits, surveys, mock audits, and external reviews conducted by CMS, NYSDOH, OMIG, OIG, and other agencies.
- Monitors operational departments for compliance with Medicare, Medicaid, managed care, utilization management, claims, grievances, appeals, credentialing, documentation, and quality requirements.
- Oversees tracking, trending, investigation, and resolution of compliance issues, complaints, incidents, and potential fraud, waste, and abuse concerns.
- Collaborates with operational leadership to develop, implement, and monitor corrective action plans resulting from audits, investigations, surveys, and identified compliance deficiencies.
- Reviews policies, procedures, workflows, and operational processes to ensure regulatory compliance and operational effectiveness.
- Conducts compliance risk assessments and recommends process improvements to mitigate organizational risk.
- Oversees preparation and submission of required compliance reports, regulatory filings, and documentation requests.
- Assists the Chief Compliance Officer with preparation of materials and reporting for Compliance Committee meetings, executive leadership, and Board reporting.
- Ensures timely completion and documentation of mandatory compliance education and training activities for staff and leadership.
- Maintains current knowledge of regulatory changes impacting MLTC, MAPD Special Needs Plans, CHHA, LHCSA, and Article 28 operations and ensures operational implementation.
- Provides guidance and support to departmental leaders regarding regulatory interpretation, audit preparedness, and compliance remediation activities.
- Maintains confidentiality and handles sensitive compliance matters with professionalism and discretion.
- Provides courteous, responsive, respectful, and knowledgeable customer service.
- Other duties and projects as assigned.
Requirements: - Bachelor's degree required; Master's degree or Juris Doctor (JD) preferred.
- Minimum of 5• 7 years of healthcare compliance, regulatory, audit, or operational oversight experience required.
- Operational knowledge of CMS, Medicare, Medicaid, NYSDOH, MLTC, MAPD/D-SNP, CHHA, LHCSA, and Article 28 regulatory requirements.
- Experience managing regulatory audits, investigations, corrective action plans, and compliance monitoring programs.
- Certified in Healthcare Compliance (CHC), Certified Professional in Healthcare Quality (CPHQ), or similar certification preferred.
- Strong analytical, auditing, investigative, organizational, and problem-solving skills.
- Excellent written, verbal, and presentation communication skills.
- Ability to interpret complex regulations and apply them operationally across multiple business lines.
- Proficiency in Microsoft Office applications and compliance/audit tracking systems.
- High ethical standards and ability to maintain confidentiality.
Physical Requirements: - Ability to sit/stand 90% of the day
- Speaking/visual/hearing ability sufficient to comprehend and express written/verbal communication
- Frequent sitting, standing, walking
- Extended periods of computer use
- Ability to express self verbally and in writing
- Ability to verbally communicate over the telephone
- Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids
Compensation & Benefits: Competitive Salary [This position is an S07 exempt position with a min-max rate of: $108,599 - $135,363/annually] with:
- Retention Bonuses
- Internal Mentoring Program
- 401K with generous Employer match
- On-Site Gym (free for all employees)
- Medical, Dental, Vision plans
- Tuition Reimbursement
- Partially funded HSA
- Employee Recognition Platform
- Paid Time Off, Holidays, Sick and Extended Sick Leave
- Short/Long term Disability
- Employee Assistance Program (EAP)
- Much More!
