Director of Compliance Risk Managment

Job Description :

Job Title : Director of Compliance Risk Management

Location : Springfield, MO

Department : Compliance and Integrity

Employment Type : Full-time

Shift : Days

Job Summary :

The incumbent strategically identifies and mitigates potential risks associated with Brightli System Members' participation in the Federal healthcare program.

The Director of Compliance Risk Management position offers...

• All-Inclusive Employee Benefits Package - A robust full-time employee benefits package encompassing health, dental, vision, retirement, disability, life insurance, wellness program, and more
• Telemedicine - 24 / 7 phone, web, or mobile app medical, behavioral health, & dermatology visits
• Employee Assistance Program - 24 / 7 counseling services, legal assistance, & financial consultation for you and your household at no cost
• Paid Time Off - 29 days per year including vacation & holiday pay
• Workplace Culture - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting healthy, joyful workforce engagement

Key Responsibilities :

• Conduct routine Compliance Risk Assessments with Brightli System Members.
• Develop and implement internal audit work plans based on Compliance Risk Assessments and ongoing billing / documentation trends.
• Update internal audit work plans regularly based on Compliance Risk Assessments and ongoing billing / documentation trends.
• Receive, analyze, and maintain internal and external audit reports.
• Oversee the development and maintenance of audit tools.
• Administer internal auditing programs per best practices and internal work plans.
• Supervise coordination of internal and external audit activities.
• Track development and implementation of corrective action plans from audits.
• Conduct and direct investigations into suspect billing for Federal health care program overpayments.
• Analyze claims data for potential fraud waste, and abuse patterns.
• Prepare and present audit activity reports to Compliance Committees and People Leaders.
• Provide guidance on coding, billing practices and documentation requirements.
• Supervise Lead Compliance Audit Coordinator and train Audit Team Members.
• Maintain work papers, files, and documentation per regulatory requirements. Ensure confidentiality of business information, including protected Health Information (PHI), as per HIPAA and company policy.

Other duties as assigned.

Experience and / or Education Qualifications :

• Bachelor's degree from an accredited college or university in Health Information Management, Healthcare Compliance or related field required.
• At least one of the following credentials (RHIA, RHIT, CHC), required.
• Three to five years' experience in healthcare related compliance, auditing or health information management.

Supervisory Requirements :

• Communicate the strategic direction of the organization and encourage participation by all team members.
• Provide leadership and guidance to all aspects of the department.
• Take an active role in monitoring the identification, development, and execution of strategic objectives.
• Involve, as appropriate, all team members to achieve goals.
• Effectively communicate to team members any changes and newsworthy events within the department or company.
• Handle difficult team member situations directly, using appropriate discretion and Human Resource advice to show respect for the individual
• Champion change and effectively manage the implementation of new ideas.
• Reinforces team approach throughout functions; support and solicit input from team members at all levels within the company.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.

Brightli is a Smoke and Tobacco Free Workplace.