Director, System Compliance in Oakland, California at Alameda Health System

SUMMARY: Director, System Compliance is responsible for supporting the Vice President, Compliance and/or the Chief Compliance Officer in the strategic planning, implementation, oversight, and continuous improvement of the Alameda Health System (AHS) Corporate Compliance Program. This role provides leadership for enterprise-wide compliance initiatives, regulatory risk management, auditing and monitoring activities, investigations, education, and compliance operations. The Director serves as a trusted advisor to executive leadership and operational departments on healthcare regulatory requirements and organizational compliance strategies while promoting a culture of ethics, integrity, and accountability throughout the organization.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.

1. Provides strategic leadership for the implementation, administration, and continuous improvement of the AHS Corporate Compliance Program consistent with federal and state regulatory requirements and industry best practices.

2. Oversees the development, implementation, and maintenance of compliance-related policies, procedures, and standards that support organizational compliance objectives and regulatory obligations.

3. Ensure effective processes are maintained to prevent the employment or contracting of individuals and entities excluded from participation in federal healthcare programs, including oversight of exclusion screening and vendor compliance activities.

4. Directs the development and administration of enterprise-wide compliance education and training programs to ensure workforce, medical staff, contractors, and vendors understand the Code of Conduct, compliance expectations, and applicable regulatory requirements.

5. Oversee confidential reporting mechanisms, including the compliance hotline and other reporting channels, ensuring concerns are promptly evaluated, investigated, and addressed while protecting individuals from retaliation.

6. Develops and implements communication strategies that promote awareness of the Corporate Compliance Program, Code of Conduct, ethical standards, and applicable healthcare laws and regulations across the organization.

7. Partners with the Vice President, Compliance and Internal Audit to develop and execute risk-based auditing and monitoring activities that evaluate compliance with applicable laws, regulations, payer requirements, and organizational policies.

8. Oversees compliance investigations and collaborate with operational leadership to ensure timely implementation, monitoring, and validation of corrective action plans designed to mitigate compliance risk and prevent recurrence.

9. Collaborates with executive leadership and operational departments to identify emerging compliance risks and develop policies, procedures, and internal controls that strengthen organizational compliance.

10. Coordinates targeted education and corrective training initiatives based on audit findings, investigations, regulatory changes, compliance trends, and identified organizational risks.

11. Serves as a subject matter expert on healthcare regulatory requirements, including Medicare and Medicaid program requirements, fraud and abuse laws, documentation standards, billing and coding compliance, clinical quality, patient safety, privacy, and related regulatory obligations.

12. Partners with the Vice President, Compliance and Internal Audit and the Office of General Counsel in responding to government audits, investigations, regulatory inquiries, and external reviews conducted by federal, state, and accrediting agencies.

13. Maintains effective collaboration with the Office of General Counsel to ensure coordinated responses to regulatory compliance issues, investigations, disclosures, and legal matters impacting the organization.

14. Collaborates with Human Resources and other business partners to establish and maintain compliance-related processes involving workforce screening, disciplinary actions, conflict of interest, Code of Conduct enforcement, and other compliance program requirements.

15. Assists the Vice President, Compliance and Internal Audit in evaluating and maintaining an effective compliance program consistent with guidance issued by the U.S. Department of Justice, the Office of Inspector General, the Federal Sentencing Guidelines, and other applicable regulatory authorities.

16. Provides strategic consultation, operational support, and executive-level assistance to the Vice President, Compliance and Internal Audit on departmental priorities, organizational initiatives, and special projects.

17. Provides guidance and operational support to the System Privacy Officer regarding privacy, confidentiality, and information governance initiatives, as appropriate.

18. Represents the Compliance Department on executive committees, multidisciplinary workgroups, and organizational governance committees, serving as a trusted advisor on compliance and regulatory matters.

19. Develops, monitors, and reports compliance metrics, dashboards, and analytics that measure program effectiveness, identify trends, and support executive and Board reporting.

20. Leads strategic compliance initiatives and continuous process improvement efforts that enhance operational effectiveness, strengthen internal controls, reduce organizational risk, and advance the organization's culture of integrity and ethical conduct.

21. Perform other related duties as assigned.

MINIMUM QUALIFICATIONS:
Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Required Education: Bachelor's Degree, Business Administration or Healthcare related field.

Preferred Education: Master’s Degree in a related field.

Required Experience: Ten year’s experience in a health care organization with direct experience in health care compliance and audit procedures.

Required Licensure/Certification: Certified in Healthcare Compliance (CHC)

Preferred Licenses/Certifications: Certified Healthcare Research Compliance (CHRC)

Preferred Licenses/Certifications: Certified Professional Coder (CPC or CCS-P)

Preferred Licenses/Certifications: Certified in Healthcare Privacy Compliance (CHPC)