Director, ACO Compliance

Description Position Summary The Director, Compliance – ACO is responsible for providing strategic leadership, operational oversight, and day-to-day management of the Accountable Care Organization (ACO) Compliance Program. This role serves as a key compliance leader, promoting a culture of ethics, integrity, and regulatory compliance across the ACO and affiliated partners. The Director oversees compliance auditing, monitoring, education, investigations, risk assessments, reporting, and corrective action activities while ensuring alignment with applicable federal and state laws, CMS regulations, OIG guidance, value-based care requirements, and organizational policies. The Director partners closely with executive leadership, operations, legal, privacy, information security, coding compliance, and clinical leadership to identify, assess, mitigate, and monitor compliance risks. This position serves as a liaison between operational teams and compliance leadership, providing strategic guidance, compliance reporting, governance support, and oversight of enterprise compliance initiatives. Essential Duties and Responsibilities Leadership and Compliance Program Oversight • Direct and oversee ACO compliance operations, monitoring activities, audits, investigations, education, and risk mitigation initiatives. • Develop, implement, and maintain an effective compliance work plan based on organizational and regulatory risk assessments. • Provide leadership and oversight for compliance staff, auditors, educators, vendors, and consultants supporting the ACO Compliance Program. • Foster a culture of compliance, ethics, accountability, and continuous improvement throughout the organization. • Support strategic compliance initiatives and organizational priorities as directed by the ACO Compliance Officer. Compliance Governance and Committee Responsibilities • Coordinate, facilitate, and participate in ACO Compliance Committee meetings and related governance activities. • Prepare committee materials, dashboards, reports, risk assessments, corrective action updates, and compliance metrics for leadership review. • Present compliance findings, trends, audit results, and emerging regulatory risks to executive leadership and compliance committees. • Maintain documentation of committee activities, decisions, follow-up actions, and compliance oversight efforts. • Participate in Board, Legal, Operational, and Executive leadership meetings as required. Strategic Planning and Operational Engagement • Collaborate with operational leadership to integrate compliance considerations into business initiatives, workflows, technology implementations, and strategic projects. • Serve as a trusted compliance advisor to clinical, operational, and administrative leaders. • Increase compliance visibility and engagement through proactive outreach, education, communication, and partnership with stakeholders. • Lead compliance-related meetings and strategic discussions involving regulatory changes, operational risks, and process improvements. • Support organizational readiness for regulatory reviews, audits, and accreditation activities. Audit, Monitoring, and Risk Management • Oversee compliance audits and monitoring activities related to documentation, coding, billing, quality, privacy, fraud, waste, and abuse, and other regulatory requirements. • Direct risk-based auditing strategies utilizing internal resources, vendors, analytics, and technology-enabled solutions. • Evaluate audit findings, identify systemic risks, and develop corrective action plans in collaboration with operational leaders. • Monitor implementation and effectiveness of corrective actions and compliance improvement initiatives. • Utilize data analytics and reporting tools to identify trends, risks, and opportunities for improvement. • Compliance Reporting and Issue Management • Investigate, document, and coordinate resolution of compliance concerns, allegations, and potential violations. • Ensure timely escalation of significant compliance risks to the ACO Compliance Officer and appropriate leadership. • Track and report compliance issues, corrective actions, investigations, and monitoring activities. • Develop executive-level reports, dashboards, and presentations communicating compliance performance and risk trends. • Maintain appropriate documentation supporting compliance program effectiveness and regulatory requirements. Education and Training • Oversee development and delivery of compliance education and awareness initiatives. • Ensure annual compliance training requirements are met and aligned with regulatory expectations. • Provide guidance and education regarding compliance requirements, policies, and emerging risks. • Support targeted education resulting from audits, investigations, monitoring activities, and regulatory developments. • Develop and oversee the annual ACO Compliance Education Plan, including compliance, regulatory, privacy, fraud, waste, and abuse, coding, documentation, and emerging risk topics. • Ensure completion and effectiveness of annual compliance training and targeted education programs based on audit findings, investigations, risk assessments, and regulatory changes. • Present compliance education to ACO leadership, committees, boards, physicians, advanced practice providers, and operational stakeholders. • Measure and report on compliance education effectiveness, participation, and outcomes as part of the organization's compliance program evaluation process. Technology and Innovation • Partner with Information Technology, Operations, and Compliance leadership to evaluate and implement technology-enabled compliance solutions. • Support utilization of AI-enabled auditing, monitoring, reporting, and compliance management tools. • Promote data-driven decision making through advanced analytics, dashboards, and compliance reporting capabilities. Values • Trustworthy: Demonstrates a high degree of integrity; keeps confidences; does what they say they will do. • Strategic thinker: Demonstrates the ability to look at the big picture and proactively develop a plan of action. • Collaborative: Demonstrates the ability to work well with others to accomplish a goal and get the work done; takes opinions of others into consideration; includes others in the decision-making process. • Committed: Demonstrates dedication to the job, project, organization, customer/clients and co-workers. • Driven: Motivated to succeed and get things done at a high level of achievement. Knowledge, Skills, and Abilities • Extensive experience in healthcare compliance, regulatory affairs, auditing, investigations, risk management, coding compliance, or healthcare operations. • Demonstrated leadership experience managing compliance programs, teams, and strategic initiatives. • Excellent communication, presentation, stakeholder engagement, and executive reporting skills. • Experience collaborating with executive leadership, compliance committees, legal counsel, operational leaders, and external partners. • Experience supporting Medicare, Medicaid, Medicare Advantage, value-based care, ACOs, risk adjustment, and physician practice compliance programs. • Experience presenting to executive leadership, compliance committees, boards, and regulatory stakeholders. • Experience conducting risk assessments, investigations, corrective action planning, and compliance monitoring. • Experience with compliance technology, audit management systems, data analytics, AI-enabled compliance tools, and reporting platforms preferred. • Professional compliance certifications (e.g., CHC, CCEP, CHPC) preferred. Education and Experience • Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Health Information Management, Public Health, Compliance, Law, Finance, or a related field required. • Master's degree in Healthcare Administration (MHA), Business Administration (MBA), Public Health (MPH), Health Informatics, Compliance, or related field preferred. • 7–10 years of progressive healthcare compliance, auditing, coding compliance, revenue integrity, risk management, regulatory affairs, healthcare operations, or related experience. • Minimum 5 years of leadership experience managing compliance, audit, operational, or regulatory functions. Salary Range: $110,000- 130,000 annually. This position is also eligible for a bonus opportunity. Exact pay will be determined based on candidate experience and geographical location.