Head of Compliance

• Policy and program development: Designs, implements, and manages the organization's

revenue cycle compliance program. This includes creating and updating policies and

procedures related to patient billing, coding, and documentation.

• Risk assessment: Conducts regular risk assessments to identify potential vulnerabilities

within the revenue cycle. This involves analyzing processes related to patient intake, charge

capture, and account receivables to detect potential issues before they lead to violations.

• Auditing and monitoring: Oversees and conducts internal audits of billing records and

medical documentation to ensure compliance with payer requirements, such as Medicare,

Medicaid, and private insurers. They also review data for improper coding, modifiers, and

documentation standards.

• Training and education: Develops and delivers compliance training programs for staff,

including billing and coding specialists, as well as clinical and administrative teams. This

ensures employees are up to date on regulatory changes and best practices.

• Investigating issues: Investigates reported or discovered compliance issues, documenting

findings, and reporting potential violations to leadership. They may also work with human

resources to determine appropriate disciplinary action for non-compliance.

• Regulatory communication: Acts as the primary liaison with external regulatory bodies and

government agencies, responding to inquiries, audits, and investigations.

• Corrective action: Develops and tracks corrective action plans to address compliance

deficiencies, following up with management to ensure successful implementation.

• Reporting: Creates and presents periodic compliance reports to leadership detailing

auditing activities, findings, risk levels, and the status of corrective actions.

• Follow up of the quality & ISMS audits and actions Conduct/formulate/co-ordinate training

programs and feedback actions related to ISO 27001:2005

• Research and recommend centralized written manuals and procedures regarding security

controls & HIPAA Controls