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Director, Compliance Investigations

4 months ago

Deerfield, United States Option Care Health Full time

Extraordinary Careers. Endless Possibilities.

With the nations largest home infusion provider, there is no limit to the growth of your career.

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 6,000 team members including 2,900 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees.

As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a

thriving workforce that is as diverse as the patients and communities we serve. Join a company that is taking action to develop a culture that is more inclusive, respectful, engaging and rewarding for all team members. We are committed to hiring, developing, and retaining a diverse workforce.

Job Description Summary: The Director, Compliance Investigations is responsible for developing and maintaining a comprehensive compliance investigation program, including managing the companys confidential ethics and compliance hotline, conducting investigations into potential compliance violations, performing root cause analysis to address compliance deficiencies, implementing corrective actions to mitigate risk, and providing guidance and reporting to stakeholders throughout the organization. Collaborates with other corporate functions to direct investigative activities to appropriate channels for investigation and resolution and to mitigate potential compliance risks. Develops, maintains, and enforces Compliances investigative and corrective action policies and procedures.

Reporting to the VP, Compliance & Privacy Operations, this individual will also assist Compliance leadership with: Developing and implementing Option Cares compliance and ethics program throughout the company to understand and adhere to legal and regulatory requirements, the Companys Code of Business Conduct and Company policies and procedures. Assessing the effectiveness of Companys compliance program and with specific compliance matters and investigations. Defining, developing, and implementing strategies to identify and address regulatory and compliance risks and trends. Ensuring that Option Care maintains compliance with all applicable laws, regulations, and internal policies related to healthcare operations.

Job Description:

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Job Responsibilities (listed in order of importance and/or time spent)

Develop, implement and maintain comprehensive compliance investigation strategies, policies and processes to identify and address potential violations of laws, regulations, and internal policies.

Direct the companys confidential Ethics & Compliance Hotline including intake, case management workflow, reporting, analytics and managing relationships with outside vendor partners.

Lead and oversee investigations into allegations of fraud, waste, abuse, and other compliance concerns, ensuring thorough and objective analysis of evidence and documentation. Manages the departments monitoring activities related to conflict-of-interest disclosure review and response.

Collaborates with other corporate functions to direct investigative activities to appropriate channels for investigation and resolution and to mitigate potential compliance risks, including but not limited to Legal, Human Resources, Quality & Risk Management, Finance and Operations. Consults with Legal department on compliance legal issues and implements processes to provide timely notification to business unit management of statutory, regulatory or policy change.

Conduct root cause analysis and implement corrective actions and remediation plans as needed to address compliance deficiencies and mitigate risks to the organization. Identifies potential areas of compliance and privacy risk and ensures escalation to appropriate individuals or groups for corrective action implementation, tracking and oversight. Monitors and maintains records of corrective measure completion.

Prepare and present regular reports on compliance investigation activities, findings, and outcomes to executive leadership and regulatory authorities, as necessary. Manages and provides oversight of documentation in and reporting from databases with reported matters used by the department.

Provide guidance and training to employees on compliance policies, procedures, and best practices, fostering a culture of ethical conduct and accountability throughout the organization. Maintains an open door policy to receive questions and concerns; provides timely responses and feedback; escalates concerns promptly to key stakeholders to facilitate problem-resolution. Develops and supports policies and programs that encourage team members to report suspected issues without fear of retaliation.

Develop and manage relationships with external partners, such as regulatory agencies, law enforcement, legal counsel and professional services organizations to facilitate collaboration and information sharing related to compliance matters and investigations. Respond to Federal, state, and/or municipal regulators or law enforcement officials related to alleged noncompliant behavior, audits, or other compliance related inquiries.

Maintain a thorough understanding of relevant healthcare laws and regulations, including but not limited to HIPAA, Stark Law, Anti-Kickback Statute, and False Claims Act, and ensure that investigative practices remain current and compliant.

Respects and maintains the confidentiality of sensitive business and patient information at all times. Maintains files and work papers consistent with Option Care Health policy and Compliance Department processes at all times.

Leverage and provide ongoing direction, oversight, coaching and development to shared Compliance staff and foster a team culture of diversity, inclusion, connectivity and professional growth.

Assists Compliance leadership with the deployment and overall operation of the Companys compliance program, including but not limited to the Annual Compliance & Privacy Work Plan, including assessing the effectiveness of Companys compliance program and with specific compliance matters and investigations and

ensuring that Option Care maintains compliance with all applicable laws, regulations, and internal policies related to healthcare operations.

Supports compliance and privacy integration initiatives with new business models.

Develop and maintain relationships with external partners, such as service providers, regulatory agencies, industry associations, and legal counsel, to stay informed of emerging compliance trends and best practices in healthcare compliance and the regulatory landscape to proactively identify areas for improvement within our programs.

Supervisory Responsibilities

Does this position have supervisory responsibilities? Yes (i.e., hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

Basic Education and/or Experience Requirements Bachelor's degree required, preferred in healthcare administration, business administration, legal or justice studies, or related field.

At minimum 8-10 years of progressive experience in healthcare compliance or comparable risk management capacity, including at least 3-5 years in a leadership or management role overseeing and conducting investigations.

Basic Qualifications Strong investigative experience: proven analytical skills, judgement and attention to detail, with the ability to conduct thorough, objective and complex investigations, analyze complex data sets, and draw actionable conclusions.

In-depth knowledge of healthcare laws and regulations, with specific expertise in compliance requirements related to billing and coding, privacy and security, and fraud, waste and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare/Medicaid reimbursement. Experience evaluating information to determine compliance with policies, standards, laws, and regulations.

Proven experience managing third parties and maintaining relationships with external partners, such as regulatory agencies, industry associations, and legal counsel, to stay informed of emerging compliance trends and best practices.

Experience representing a company and interacting with senior level management, legal counsel, federal and state regulators and law enforcement on compliance and privacy matters.

Experience monitoring changes in healthcare laws and regulations, assessing the impact on the organization, and updating compliance programs and policies accordingly.

Excellent communication and interpersonal skills, with the ability to build relationships, influence stakeholders, and communicate complex compliance concepts in a clear and concise manner.

Demonstrated leadership and management capabilities, including the ability to inspire and motivate a high-performing team, foster a culture of integrity, accountability and excellence, and drive results in a dynamic and fast-paced environment through collaboration and teamwork.

Experience developing strategic initiatives which align with business goals and budget, drive efficiencies and foster team collaboration. Experience supporting leadership with development of annual workplans, budgets resource planning and reporting.

Experience participating in ongoing risk assessments to identify potential compliance risks and vulnerabilities within the organization, working collaboratively with cross-functional teams to develop and implementing mitigations.

Demonstrated ability to independently plan projects, identify objectives and targets, and execute deliverables on-time and on budget while partnering collaboratively with key stakeholders.

Intermediate to Advanced proficiency in Microsoft Office Suite and experience with compliance software, case management systems and data analytics and reporting tools.

Physical Demand Requirements Ability to sit and work on a computer for extended periods of time.

Travel Requirements: (if required) Willing to travel up to 25% of the time for business purposes (within state and out of state).

Preferred Qualifications & Interests (PQIs) Certifications in investigation, interview, and/or fraud examiner techniques

Advanced degree (e.g., JD, MBA, MPH) or clinical certification

Direct experience with a healthcare provider or pharmaceuticals

Direct experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines

Certified in Healthcare Compliance (CHC), Certified Compliance and Ethics Professional (CCEP), or similar certification preferred.

Due to some state pay transparency laws, below is the minimum pay for the position: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Minimum pay is $139,536.79+ Benefits: -401k -Dental Insurance -Disability Insurance -Health Insurance -Life Insurance -Paid Time off -Vision Insurance

Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information. ?

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