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The Director of Compliance, Audit and Privacy provides operational compliance/advisory support to Advocare, LLC, its Care Centers and physician members. Reporting to the Chief Legal Officer and to the President and Chief Executive Officer, this position is responsible for developing and maintaining a program within Advocare, LLC to demonstrate a compliance culture through understanding and compliance with federal and state laws and regulations, professional standards, private payor policies and Advocare, LLC's Code of Conduct. The Director of Compliance, Audit and Privacy will develop action plans to implement new statutory and regulatory mandates and, in collaboration with key stakeholders, lead the implementation of these plans. This position will play a key role in the annual risk assessment process and support the implementation of mitigation activities.
Provide compliance advisory support and direction for applicable legal and regulatory requirements and mitigate compliance risks;
Conduct audits, documentation/coding reviews and supplemental analysis in preparation for state and client audits, and assist with the coordination of internal and external audit requests;
Review, evaluate, investigate and resolve compliance and HIPAA issues and concerns to assure compliance with regulatory standards, and applicable laws and regulations;
Work collaboratively with leadership teams to establish and implement policies and procedures addressing areas of significant legal, regulatory or other compliance risks;
Identify potential legal and compliance deficiencies and/or compliance/HIPAA risks and recommend mitigating processes designed to achieve adherence;
Partner with leadership to lead buildout of a strategic and comprehensive privacy program which defines, develops, maintains and implements policies and processes which enable consistent, effective privacy practices to minimize risk and ensure the confidentiality of protected health information (PHI);
Ensures privacy policies and forms are up-to-date;
Serves as a liaison for patient privacy contacts;
Works with applicable members of organizational leadership to establish governance for the privacy/compliance program;
Develops and conducts all HIPAA/compliance training and awareness activities within Advocare, LLC;
Cooperates and/or partners with the U.S. Department of Health and Human Service's Office for Civil Rights, state regulators and/or other legal entities in any compliance reviews or investigations;
Serves as a technical resource on documentation, coding, billing, and general compliance questions related to primary and specialty Care Centers;
In collaboration with members of Compliance and Quality Committees, identifies and implements strategic initiatives for compliance risk areas for which this position is directly responsible;
Participates in and advises on compliance-related aspects of organizational business development initiatives;
Fulfill additional assignments and responsibilities as needed; and
Strategically addresses and escalates key compliances risks to the Chief Legal Officer, President and Chief Executive Officer and, when necessary, the Board of Managers to ensure organizational accountability.
Minimum of six (6) years prior compliance experience which may include risk assessment and audit experience;
Prior work experience in the healthcare industry;
Compliance related certification preferred (Certification in Healthcare Compliance (CHC); Certification in Healthcare Privacy Compliance (CHPC) and/or Certified Compliance and Ethics Professional (CCEP));
Bachelor's degree or equivalent work experience required;
Demonstrated effectiveness operating in complex organizational and regulatory environment;
Ability to excel in a fast-paced environment with multiple service locations and a broad set of diverse stakeholders, including physician leaders;
Strong attention to detail and commitment to project ownership, accuracy and completion on a timely basis;
Experience with monitoring and ensuring compliance with state regulatory requirements and experience in interpreting state and federal laws;
Professionally skilled in personal presentation, verbal and written communication;
Strong interpersonal skills with the ability to effectively listen and communicate to varied levels;
Consulting experience, especially focused on complex, highly regulated industries, is a plus;
Ability to travel to Care Centers as needed;
Demonstrated computer skills including Microsoft Office's suite of software applications; and
Strong problem solving, risk analysis and project management skills and the ability to work with minimal supervision.
About Advocare, LLC
Advocare, LLC is an integrated independent physician owned and governed multi-specialty medical organization which delivers exceptional care throughout New Jersey and Pennsylvania. It includes pediatricians, family practice physicians and specialists, each of whom has strong bonds to the children, adults, families and communities they serve. Advocare physicians promise to bring to each patient their vast experience, a pursuit of continuing education and a true love for the practice of medicine. They are proud to provide the highest quality healthcare with a personal, caring touch which focuses on the health, safety, well-being and overall needs of their patients and their families. Advocare physicians offer medically-integrated excellence for every healthcare need in life. For more information visit www.advocaredoctors.com