Compliance Auditing & Monitoring Director - Hybrid

OVERVIEW OF POSITION:

Partner with and consult directors, senior management and operations to review regulatory, governmental, and contractual requirements; implement appropriate compliance auditing, monitoring and procedures to ensure the organization is meeting compliance standards according to pertinent federal, state, and local regulations, third-party guidelines and industry standards in the delivery of services and documentation. Directs and executes a comprehensive , enterprise-wide auditing strategy, function, and practice to mitigate risk by adhering to healthcare and other auditing standards and regulatory requirements, as well as healthcare reimbursement compliance.

We are seeking candidates based in Southern California only.

Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of any employment visa at this time.

Starting Hiring Range: $110k - $140k / yr. 

ESSENTIAL FUNCTIONS:

• Ensures that all activities follow regulatory requirements related to the governance of the organization as well as any industry-specific or location-specific laws.
• Oversees internal controls and auditing systems that monitor and report on regulated activities and processes.
• Develops risk-based compliance testing of existing procedures and controls to identify, detect, and correct noncompliance.
• Evaluates and implements changes to compliance processes due to new or amended regulations.
• Establishes communication and training initiatives that inform stakeholders about compliance requirements as needed.
• Responsible for establishing a compliance plan that oversees, prevents, and/or detects violations of law, regulations, policies, or code of conduct by estimating, forecasting, and anticipating requirements, evaluating trends, establishing critical audits and measurements, accumulating resources, and resolving problems reasonably and realistically.
• Collaborates with department heads to conduct risk assessments and develop work plans to address identified risks to ensure that internal controls are capable of preventing and detecting significant instances or patterns of illegal, unethical, or improper conduct and enforce adherence to department risk policies, procedures, and best practices.
• Acts as an independent reviewer and evaluator to ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and resolved.
• Ensures the organization adheres to regulations and best practices when seeking payments for services. This includes accurate claim submission, adherence to coding guidelines, and understanding payer-specific and contractual requirements.
• Analyzes, compiles, and summarizes appropriate data, information, and trends for reporting purposes and validate results for dissemination while offering appropriate and pragmatic suggestions for improvement.
• Monitors and identifies critical control points, audit, advise, and establish reasonable and realistic measures for corrective actions to minimize the impact of noncompliance.
• Collaborates with directors, management, and senior management Department Heads to identify effective training, including introductory and on-going training and a method for tracking compliance to address continuous quality improvement needs throughout the organization
• Develops and coordinates appropriate compliance training and education programs for all employees.
• Stays abreast of regulatory requirements from all Federal, CA State, and regulatory and oversight agencies, including but not limited to ACS [Administration of Children’s Services], HRA [Human Resources Administration], DOHMH [Department of Health and Mental Hygiene], OCFS [Office of Children and Family Services], OMH [Office of Mental Health], DOH [Department of Health], OMIG [Office of Medicaid Inspector General], HHS [Health and Human Services], and CARF [Commission on Accreditation of Rehabilitation Facilities]; ensure updated regulations and guidance are appropriately communicated to the directors, management, senior management of the organization.

EDUCATION:

• A bachelor's degree in business management, legal, social services, humans services, or equivalent field is preferred.
• Certified Compliance and Ethics Professional (CCEP), and/or Certified Risk and Compliance Management Professional (CRCMP), and/or Governance, Risk and Compliance Professional (GRCP) certifications are preferred.

EXPERIENCE:

• A minimum of five (5) years of experience in non-profit or compliance management industry, or related entity.
• Proven success navigating audits, inspections, and regulatory agencies—experience in internal compliance in the non-profit field is a major plus.
• Exceptional ability to communicate, influence, build trust, and connect with stakeholders at all levels.
• Deep knowledge of non-profit operational and quality assurance practices for healthcare and human services organizations.
• Direct work experience within a nonprofit organization and governmental contract knowledge is preferred.

KNOWLEDGE, SKILLS, ABILITIES:

• Decisions generally include oversight, management and coordination of compliance related concerns. Strong analytic skills and ability to rapidly assimilate complex information. Strong influencing skills with the ability to generate support and build consensus.
• Should possess a thorough understanding of industry requirements and transactions or related experience and all related departments’ roles in such transactions.
• Creativity and an out of the box approach are required to improve all areas of responsibility.
• Interact with other departments or divisions to ensure cooperation and the delivery of proper services.
• A friendly, engaging personality a plus to work with internal departments to research and resolve compliance issues.
• Develops functional and practical compliance strategies that align with organizational objectives by contributing information, analysis, and making beneficial recommendations of policies, and procedures to senior management, department heads, colleagues, and other stakeholders.
• Proven hands-on responsibility for the full scope of an administrative management/leadership position.
• In-depth understanding of the industry including risk management, compliance, and regulatory requirements.