National Director, Integrity & Compliance
The National Director of Integrity and Compliance administers the Company’s Investigations Program at an enterprise level. The position is responsible for overseeing all investigative activities and resolution actions for all investigation categories. This position ensures allegations of noncompliance and misconduct are thoroughly investigated and resolved appropriately. The National Director of Integrity & Compliance ensures all Company investigations are handled in a manner consistent with regulatory guidance documents from the Department of Justice, the Department of Health and Human Services’ Office of Inspector General, the Centers for Medicare and Medicaid Services, and other applicable regulatory entities, as well as internal guidance documents including the code of conduct, the Encompass Health Investigations Protocol, and applicable policies including the Company’s non-retaliation policy, subject in all instances to applicable law. This position also makes recommendations for company-wide process improvements based on identified trends gleaned from investigative activities.
Responsibilities
Coordinates investigative efforts with various Risk Management Units.
Analyzes reports or investigation findings for patterns of misconduct or other red flags that indicate compliance weaknesses.
Develops and oversees investigator training program, to include developing investigation training materials.
Provides instructor-led training on investigation processes as needed.
In conjunction with HR and operational leaders, ensures disciplinary measures are effective, consistent and commensurate with findings, when necessary.
Performs hotline data analytics and creates reports based on hotline data (“Hotline data” includes reports of noncompliance from all from all relevant sources).
Provides Investigation Program input for the annual compliance Work Plan, quarterly Board of Directors meetings, and Executive Compliance Committees.
Chairs the Investigations Review Committee.
Contributes Compliance Newsletter content.
Provides input to Ethics & Compliance Audit & Monitoring program leaders based on identified trends and other notable events.
Organizes, plans, and manages time effectively to complete assignments.
Meets position requirements and performs essential functions.
Completes mandatory training and courses required by completion date.
Reports questionable situations, concerns, complaints or harassment immediately.
Performs other duties as assigned, to be determined by the Chief Compliance Officer.
License or Certification:
Certified in Healthcare Compliance (CHC®) or other applicable professional certification.
Certified Fraud Examiner (CFE®) or Accredited Health Care Fraud Investigator (AHFI®) certifications a plus.
Minimum Qualifications:
Bachelor’s degree in business, finance, accounting, human resources, or related field required.
Juris Doctor, Master of Science, or Master of Business Administration preferred.
Experience performing investigations, particularly in a health care environment, highly preferred.
Minimum of five years’ experience in the health care industry, with operational and/or compliance experience a plus.
In-depth knowledge of regulatory requirements regarding health care compliance programs and Medicare billing rules highly preferred.