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In-House
Attorney
Health Care
Min 12 yrs required
Director of Compliance, Billing The candidate will provide oversight of firm’s Global Corporate Compliance and Ethics Program (“Programâ€), including but not limited to, management and enhancement of the Program with a focus on the Company’s billing compliance. Will work closely and collaboratively with leaders of the billing organization to ensure compliance with all applicable laws, regulations and requirements. Develop Program policies and procedures, training, initiation and conduct confidential investigations, develop and implement corrective action plans, perform audits, conduct analysis of complex state and federal laws, regulations and Medicare billing policies related to DMEPOS suppliers, ensure compliance with Program policies and procedures, Medicare Supplier Standards, National Supplier Clearinghouse requirements, DME MAC requirements, Accreditation requirements, HIPAA privacy and security, and DME licensure. Ensure on-going culture of compliance and prevention of illegal and unethical conduct. Responsible for managing the day to day operations of compliance polices and procedure for firm’s billing operations within the overall Compliance Program. Consults with businesses to identify, formulate and implement policies and procedures to ensure compliance with federal, state, agency, legal, regulatory and internal requirements, including but not limited to billing Medicare, Medicaid and other government healthcare programs and selling and billing durable medical equipment, prosthetics, orthotics and supplies (“DMEPOSâ€). Develops compliance training program and modules to ensure the effective implementation of policies and procedures. Provides compliance related expertise, advice and counsel to the billing department with respect to day to day operations. Conduct and document investigations of alleged compliance violations, including hotline reports, and resulting corrective and preventative actions. Develops annual audit plan and performs audits of billing operations and other high risk areas as appropriate. Ensures coordination and communication within the Company on compliance matters. Coordinates site, agency or other audits and examinations conducted by external parties, including Medicare, State Board of Pharmacy and other licensing boards, and accreditation organizations. Monitors rules, regulations, industry standards and regulatory enforcement relating to government billing and DMEPOS suppliers and implements appropriate changes to the compliance program. Oversees and prepares responses to customer inquiries, requests and complaints. Prepares management reporting.
Qualification and Experience
The candidate should have 12+ years of experience with a focus on the health care industry, preferably with a medical device manufacturer and/or DMEPOS supplier. In-depth knowledge of healthcare compliance and applicable laws, regulations and standards (e.g., fraud and abuse, HIPAA, Stark, Anti-Kickback, Medicare reimbursement, Medicare Supplier Standards, DMEPOS Quality Standards etc.), preferably as they apply to medical device manufacturers and/or DMEPOS suppliers is essential. Must have BA/BS or Equiv Work Experience. 15+ years of experience is preferred. Juris Doctor Degree or Master Degree; Compliance Certification is preferred.
R18-1324
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