Director, Compliance
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Position Title: Director, Compliance
Reports To: Chief Legal Officer
Division: AA – CORPORATE EH-SS
Department: Legal and Compliance
Classification: Non-exempt
Places of Work: Remote
People Leader: No
About the Organization:
Equality Health is an integrated, holistic, and tech-enabled healthcare delivery system focused on improving the health and wellness of diverse populations. Founded in 2015, Equality Health aims to improve access to value-based care for people who have long struggled with navigating the traditional one-size-fits-all U.S. healthcare system. The mission of the company is to provide high-quality care that improves and enhances lives regardless of race, ethnicity, age, or income.
Through its supplemental care management services and proprietary technology platform, CareEmpower™, Equality Health helps managed care plans and health systems improve outcomes and lower costs for diverse populations while simultaneously facilitating the transition to risk-based accountability. Equality Health supports over 800,000 members and more than 4,000 practice sites and continues to scale rapidly.
In 2021, Equality Health partnered with General Atlantic, a leading global growth equity firm, to help drive continued expansion and fuel the next phase of growth as a leading value-based primary care network serving the Medicaid, Medicare and ACA Exchange populations. This strategic investment will enable Equality Health to pursue further geographic expansion, technological innovation and product development while furthering its mission of increasing access to care, lowering costs and improving outcomes for underserved individuals, families and communities.
About the Role:
The Director of Compliance will oversee the corporate compliance and privacy program that covers multiple lines of business and across multiple states, and includes compliance with the rules and regulations of the Centers for Medicare and Medicaid Services, as well as state Medicaid agencies. Responsibilities include, but are not limited to, the development and standardization of policies and procedures for compliance, auditing and monitoring, training and education, compliance investigations, and reporting and ensuring compliance with all state and federal privacy laws.
Key Responsibilities:
- Maintains up to date knowledge of federal and state regulations applicable to various lines of business.
- Fosters a culture of integrity and transparency.
- Chairs the Company’s Compliance Committee.
- Ensures corporate policies are accurate, current and in compliance with federal and state regulations.
- Reviews policies and procedures, clinical and non-clinical.
- Reviews Business Associate and Data Access and Use Agreements.
- Interprets and disseminates information on regulatory and compliance matters.
- Educates and trains all employees regarding compliance topics.
- Manages compliance hotline process, which includes investigation, follow up, and corrective action if necessary.
- Conducts internal audits to ensure compliance with Stark, Anti-kickback, Conflicts of Interest, Fraud, Waste and Abuse, and other relevant laws and regulations.
Required Skills & Qualifications:
- At least 8 years in healthcare compliance with federal programs including Medicaid and Medicare.
- Strong understanding of Medicare and Medicaid reimbursement, Fraud, Waste and Abuse, HIPAA, Anti-Kickback Statute, Stark and state healthcare privacy laws.
- Direct Care/Clinical Compliance experience preferred
- Bachelor’s Degree in related field
- Compliance Certification preferred
- Excellent communication skills
- Good interpersonal and organizational skills
- Some travel may be required <10%
Equality Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.
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