Vice President of Compliance - Remote (US)

Full Time Vice President of Compliance - Remote (US)

Employment Type: Full-time, salaried, exempt

Compensation: TBA

Job Location: Remote (US)

Job Highlights:

• Work-Life Balance: Monday to Friday schedule for a fulfilling personal and professional life.
• Competitive Compensation: Be rewarded with a generous salary and benefits package.
• Career Growth Opportunities: Unlock your potential and advance in your career with our support.
• Supportive Work Environment: Join a team that values and appreciates your contributions.
• Comprehensive Training: Enhance your skills and knowledge through our extensive training programs.
• Compliance and Peace of Mind: Work with confidence knowing that we prioritize compliance with employment laws and regulations.
• Paid Time Off and Holidays: Enjoy well-deserved time off to relax and recharge.
• Life Insurance Coverage: Protect your loved ones with our employer-paid life insurance policy.
• Collaborative Team Environment: Thrive in a positive and collaborative work environment.

Company Overview: 

Theoria Medical is a comprehensive medical group and technology company dedicated to serving patients across the care continuum with an emphasis on post-acute care and primary care. Theoria serves facilities across the United States with a multitude of services to improve the quality of care delivered, refine facility processes, and enhance critical relationships. We offer a broad scope of services including multispecialty physician services, telemedicine, remote patient monitoring, and more. We currently operate primary care clinics and provide medical services to skilled nursing facilities in numerous states across the nation. 

As a leading edge, innovative, and quality driven physician group, we continue to expand nationally. The Director of Compliance is responsible for overseeing the compliance program, which, through its policies and procedures, monitoring and auditing functions, and training and education, is designed to prevent, detect, and mitigate regulatory risk for the company.  The Director of Compliance will ensure the compliance program promotes an organizational culture that fosters ethical business behavior and ensures compliance with all Federal and State healthcare laws and regulatory requirements. 

The Director of Compliance will report to the [CCO, CEO, or General Counsel] and has access to the Board of Directors if needed to report on the status of the compliance program, including tactics for prevention of regulatory risks, detected regulatory risks, and mitigation strategies.

Shift Structure: 

• …

Responsibilities: 

• Implement and monitor the Compliance Program.
• Create employee awareness of the Compliance Program.  Emphasize the employee’s responsibility to be knowledgeable of and comply with applicable federal and state healthcare laws.
• Create/review/revise compliance policies and procedures as needed.  Ensure new and updated compliance policies and procedures are communicated to organizational leadership and employees.
• Provide training and education and/or develop regular communication on a variety of compliance-related topics, including but not limited to, Fraud, Waste and Abuse Laws, Anti-Kickback Statute, False Claims Act, HIPAA, etc.  Ensure organizational leadership and employees are provided with the most up-to-date information at the time laws regarding compliance-related topics are updated.
• Maintain current working knowledge of federal and state regulations and policies as they affect the company through routine review of various CMS manuals, Federal Register notices, applicable government and/or industry-related internet information sites, and state Medicaid manuals.
• Maintain a system for reporting potential compliance concerns, including the creation of a compliance helpline for anonymous reports or inquiries from employees.
• Protect the confidentiality of employees who make inquiries or report violations.
• Develop and implement annual compliance risk assessment and work plan.
• Conduct periodic reviews of the compliance program and make revisions in consideration of changes in the organization's needs and/or the statutes, rules, regulations, and requirements of federal and state health care programs.
• Conduct investigations of reported or identified compliance matters received and advise on appropriate corrective actions.
• Conduct monitoring and auditing processes to evaluate ongoing compliance of key compliance risks as identified through the risk assessment process, government enforcement efforts, and/or reported compliance concerns.
• Implement corrective action plans developed as a result of a reported or identified compliance matter to ensure appropriate follow-through.
• Communicate detected regulatory risks to organizational leadership and pertinent operational employees and provide additional training and education and/or disciplinary action as needed.
• Develop and maintain a positive rapport with payors, CMS, and other applicable federal/state government agencies.
• Act as Chair of the company Compliance Committee which provides an opportunity to report to the Executive Officer and other Executive Leadership regularly on compliance-related matters.
• Report to the Board of Directors on compliance-related matters, as needed.
• Responsible for hiring, training, development, and performance management of the compliance team.
• Responsible for leading and supporting the compliance team through performance evaluations and counseling and/or provision of disciplinary actions, if necessary.

Requirements and Qualifications:

Education/Licensing/Certification:

• Bachelor’s degree in healthcare, business, or an organizational-related field or comparable corporate experience
• Master’s Degree in hospital or business administration, or related field, preferred (MBA or MPH)
• Certification in healthcare compliance is preferred.

Experience:

• Five or more years of experience specific to healthcare compliance matters is required.

Knowledge and Skills:

• Strong verbal and written communication skills.
• Excellent interviewing, negotiating, and interpersonal skills.
• Experience in establishing relationships with organizational leaders, board members, staff, and other healthcare industry leaders.
• Ability to deal effectively at all levels of the organization in ways that enhance understanding, respect, cooperation, and problem-solving.
• Thorough familiarity with relevant laws and regulations, including anti-kickback, false claims, and HIPAA.
• Thorough understanding of the regulatory environment of healthcare, ethics, pertinent legislation, OIG, OCR, and other regulatory agency processes.
• Ability to manage responses to government inquiries, including carrier audits, federal investigations, and direct outside counsel with respect to criminal and civil litigation.

Preferred Areas of Knowledge:

• CMS Guidelines for physician groups, skilled nursing facilities, etc
• Contract Law
• Employment Law and regulations 
• Federal False Claims Act
• Stark Law 
• Anti-Kickback Statute 
• MIPS/MACRA 
• 2015 ONC Certification 
• Health IT guidelines 
• HHS OIG Work Plan 
• All other regulations related to the business of Theoria Medical as a physician practice and health technology company 

Physical Requirements

• Must be punctual or on time and adhere to the company's Time and Attendance policy.
• Must be able to remain sitting for the majority of their shift.
• Continuous operation of app-based programs (monday.com, google suite of docs) and other web or technology-based programs and applications.

Compensation and Benefits: 

• PTO and holidays
• 401k with employer match
• Health Insurance 
• Dental Insurance
• Vision insurance

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