Associate Director, Compliance Initiatives

The Associate Director leads the resolution of complex compliance issues by conducting thorough analysis, research, documentation, and reporting, while collaborating with relevant stakeholders to ensure the Office of Institutional Compliance receives accurate and actionable information to support timely, well-informed decisions that advance organizational compliance objectives.

The Associate Director leads the resolution of complex compliance issues by conducting thorough analysis, research, documentation, and reporting, while collaborating with relevant stakeholders to ensure the Office of Institutional Compliance receives accurate and actionable information to support timely, well-informed decisions that advance organizational compliance objectives.

• Partners with Compliance Attorneys and/or other management teams throughout the institution to research deficiencies, conduct investigations, and develop post-review memorandums, which include guidance and recommendations for issues related to HIPAA violations, conflicts of interest (COI), patient and employee hotline allegations, billing disputes and others compliance related concerns.
• Performs, or assists in the performance of, special reviews or investigations at the request of management.
• Serves as project lead for external reviews performed by regulatory agencies and non-regulatory agencies (such as consulting firms). Updates the investigation and audit tracking databases, as necessary.
• Works closely with Revenue Cycle Operations, Medical Records, and other departments to ensure that records requests and appeals are timely submitted for various auditing bodies such as Medicare, Medicaid, RACs, HRSA, MSP, ADR, CERT, SMRC, OIG (federal and state), etc. Develops various auditing workflows by payor, which identify the department(s) that is/are responsible for each step in the process.

• Works in close collaboration with other Compliance staff and/or other management teams throughout the institution to ensure program-wide compliance efforts are in alignment with the Centers for Medicare & Medicaid Services (CMS), Texas Health and Human Services Commission (HHSC), Commercial Payors, and other Federal and State regulatory requirements.
• Serves as the institutional liaison with regulatory agencies, including but not limited to, the Medicare Administrative Contractor, the Center for Medicaid and Medicare Services, TXHHSC, Recovery Audit Contractors (RACs), Texas Medical Board (TMB) and other payors and regulatory bodies for requests for information, including triaging and overseeing outside regulatory agency reviews and audits and requests for information, and communicating with regulatory agencies in determining the direction, theory, scope and procedures to be used in compliance reviews.
• Provides reports to executive leadership regarding current and/or expected audit activity, trends, financial exposure, and remediation or corrective measures.
• Provides strategic recommendations for corrective and mitigation actions in response to regulatory or internal reviews, ensuring compliance processes and functions are strengthened and aligned with organizational and regulatory requirements.

• Maintains comprehensive knowledge of evolving rules, regulations, and guidance issued by the State Legislature, CMS, TXHHSC, Medicare Administrative Contractors, and other regulatory or oversight entities to ensure organizational compliance functions remain current and effective.
• Leads or contributes to the development and delivery of training and educational programs for compliance staff, including monitoring audit contractor publications and websites, and actively participating in professional forums such as Novitas, Novitasphere, HMS Medicaid RAC, Cotiviti RAC, Performant, VA RAC, Federal and State OIG, and CMS Open Door Forums, to ensure the team is informed of emerging trends and regulatory changes.
• Serves as a subject-matter resource for complex compliance questions, supporting staff and leadership in interpreting regulatory requirements and applying them to organizational operations.
• Collaborates with internal departments to implement best practices and standard operating procedures that ensure consistent adherence to federal, state, and payer regulations.

• Chairs the Audit Request and Appeals meetings and the Compliance Oversight Committee (COC), establishing strategic agendas, guiding…