The Director of Compliance and Privacy serves as the Compliance and Privacy Officer for the ACO and VBC entities. This role is responsible for implementing the Cone Health system-wide compliance and privacy programs with specific focus on the VBC entities and activities. Functioning as an objective reviewer and evaluator of compliance issues and concerns for the VBC entities, the Director of Compliance and Privacy investigates and reviews activities for the purpose of supporting regulatory compliance and ensuring integrity in business practices.

The Director of Compliance and Privacy's general duties and responsibilities encompass supporting the implementation of systems, processes and policies designed to ensure compliance with federal and state healthcare program requirements for the Cone Health VBC entities. This position evaluates, analyzes, or assesses the risks associated with business processes including coding and billing, work plans, regulations, and policies. Conducts risk assessment, root cause analysis, performance metrics, process design, and technology pre-implementation. The Director of Compliance and Privacy oversees the work of compliance personnel across the Cone Health provider networks by working with staff and physicians to assure that the provider network and VBC activities are compliant with regulatory standards. This person is highly engaged with all levels of employees within the Cone Health Care System.

This role reports to the Cone Health Systemwide Vice President, Chief Compliance and Privacy Officer and the appropriate Value-Based Care (VBC) governing board(s) with a dotted line reporting structure to the THN Chief Administrative Officer and the Executive Director, Value Based Care.

This is a hybrid role requiring regular onsite work.

Talent Pool: Leadership

#LI-Hybrid

Reporting directly to the Cone Health Vice President, Chief Compliance and Privacy Officer, the Director of Compliance and Privacy,VBC is responsible for overseeing, managing, and monitoring the day-to-day compliance and privacy activities resulting in effective compliance and privacy programs.

Develop and implement compliance and privacy policies, procedures, and best practices to position the Cone Health and THN compliance departments as key partners in ensuring the success of Cone Health's and THN's mission, values and strategic initiatives.

Develop and implement a comprehensive training and education program that focuses on the elements of the compliance and privacy program and seeks to ensure that all employees and participating providers are knowledgeable of and comply with relevant federal and state standards.

Develops and implements compliance auditing and monitoring programs, policies and procedures for detection, response, resolution and reporting, including identification of potential areas of compliance vulnerability and risk, and development of corrective action plans.

Maintain effective communication with department staff as well as key stakeholders, and consistently demonstrate high standards of professional conduct and ethics, as well as appropriate judgment, independence, and discretion.

Maintains an effective compliance communication program, including promoting the use of the Compliance hotline, heightened awareness of applicable policies and procedures and the Code of Conduct, and understanding of new and existing issues and related policies and procedures.

Maintains and updates tools, technology and resources including reference library, intranet and website, newsletters, videos, and other resources.

Oversees the compliance staff who assist in the continued development and ongoing implementation of an effective compliance and privacy program.

Responds to alleged compliance violations and privacy breaches. Ensures that compliance issues and concerns within are being appropriately identified, evaluated, investigated and resolved.

REQUIRED:
Bachelors' Degree in business, health care administration, or a related field.

PREFERRED:
Master's Degree in business, healthcare administration, or a related field.

REQUIRED:
Minimum 5-7 years demonstrated experience leading health care regulatory and compliance functions.
Understanding of Federal Healthcare programs, initiatives, and health policy.

PREFERRED:
Experience in a leadership role and five (5) years' experience in compliance program development within an ACO, value based care model, or clinically integrated network.
Experience with commercial and government ACOs, clinical case management, population management, and/or monitoring alternate payment methodologies (bundled payments).
Experience in conducting compliance investigations and managing and resolving compliance issues.
Experience in auditing physician compensation, contracts, and incentive models.
Experience in working with regulatory agencies and knowledge of ACO compliance programs and OIG/DOJ Compliance Program Guidance.