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ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
compliance program designenterprise risk assessmentaudit and monitoringregulatory change managementgovernment inquiries managementcompliance diligenceAI governanceprogram integritybilling and codinghealthcare compliance
Soft Skills
leadershipcommunicationstrategic thinkingproblem-solvingteam developmenthigh judgmentcollaborationadaptabilitycredibilitydecision-making
Tools & Technologies
compliance management systemsreporting channelshotline systemsauditing toolstraining platformsdata analytics toolsvendor management systemsclinical workflowspolicy management softwarerisk assessment tools
Industry Keywords
OIG seven-element frameworkDOJ Compliance Programs guidanceAKSStarkFCAHIPAAHITECHCMSHRSAMedicaid
About the role
Key responsibilities & impact- Design, build, deploy, and continuously improve a comprehensive enterprise compliance program covering every aspect of Abby Care's healthcare operations, anchored to the OIG seven-element framework and the DOJ's Evaluation of Corporate Compliance Programs guidance.
- Set the company's compliance strategy and priorities, including the annual enterprise risk assessment, multi-year work plan, audit and monitoring calendar, and annual program effectiveness review; secure the resourcing and Board endorsement to execute against them.
- Establish and operate the program's full operational backbone — policies and procedures, training and culture, reporting and hotline channels, monitoring and auditing, investigations, discipline, and corrective action — and ensure each element is functioning, measurable, and improving.
- Lead compliance across the full program lifecycle, clinical operations, documentation, billing and coding, EVV, payor and MCO contract performance, and program integrity; and work to build a culture of compliance by embedding compliance into how the business runs rather than bolting it on.
- Lead regulatory change management across the federal stack (AKS, Stark, FCA, HIPAA/HITECH, CMS, OIG, HRSA, and the 21st Century Cures Act) and across each state Medicaid environment in which we operate.
- Manage all government inquiries, audits, investigations, self-disclosures, and any settlement or CIA obligations; serve as the company's principal compliance liaison to regulators, MCO program integrity functions, and external counsel.
- Partner with Legal, People, Operations, Clinical Leadership, Information Security, and Finance to embed compliance controls across the workforce, software and vendor ecosystem, and care delivery model.
- Partner with the General Counsel on compliance initiatives regarding AI governance and the deployment of AI in clinical and operational workflows, including FDA SaMD/CDS analysis, documentation integrity, and patient-facing disclosures.
- Lead compliance diligence and integration for new market entry, new Medicaid program design, new service lines, and M&A activity.
- Serve as the company's designated Compliance Officer; chair the Compliance Committee; report regularly to the Board on risk posture, incidents and program effectiveness, with independent access as needed.
- Build, hire, and develop a high-performing in-house compliance team, investigations, auditing and monitoring, training, and compliance operations and analytics, and the technology infrastructure that supports a modern program.
Requirements
What you’ll need- 10+ years of progressively senior compliance experience at a healthcare company, including 5+ years at the Director level or above.
- A track record of designing and building, or materially rebuilding and scaling, an enterprise compliance program, not solely operating an established one.
- Demonstrated end-to-end ownership across all seven OIG compliance program elements, not partial ownership of one or two pillars.
- Substantial experience at companies funded by government healthcare programs (Medicaid, Medicaid waivers, Medicare, and managed Medicaid).
- Working command of the federal healthcare regulatory stack (AKS, Stark, FCA, HIPAA/HITECH, CMS and OIG guidance) and of state Medicaid program integrity requirements.
- Multi-state operating experience and the range to manage a comprehensive, systems-based program across several state Medicaid environments simultaneously.
- High judgment on risk tradeoffs, strong written communication, and the credibility to take and defend a position with executives, the Board, and regulators.
- Comfort operating in a fast-growth environment with imperfect data, competing priorities, and the need to write the policy yourself before handing it off.
Benefits
Comp & perks- Health insurance
- Remote work options
- Professional development opportunities