Managing Director Lubbock
44654BR
Position DescriptionPlans and directs the overall operation of a complex area/department and provides leadership for staff members. Under executive direction, performs highly varied administrative duties involving the use of independent judgment and professional skills. Responsible for all employees assigned to area.
Major/Essential Functions1. Compliance Program Leadership & CRCO Support
- Serve as a trusted advisor to the CRCO by maintaining current awareness of evolving federal and state healthcare laws, billing and coding regulations, privacy requirements, and payor policies.
- Assist the CRCO in monitoring and responding to changes in state and federal statutes, CMS conditions of participation, and commercial payor contract requirements.
- Represent the compliance program before the CRCO, Institutional Risk and Compliance Committees, and other governance bodies as appropriate.
2. Clinical Compliance Operations & Stakeholder Engagement
- Serve as the primary institutional point of contact and subject matter expert for all clinical compliance matters, including billing, coding, documentation, and related regulatory requirements.
- Develop and maintain a two-way line of communication with billing and coding compliance team members, clinical leadership, and operational stakeholders to identify compliance needs and provide timely guidance.
- Liaise regularly with Regional Executive Teams and coordinate system-wide compliance activities including dashboard reporting, audit summaries, policy implementation, and committee presentations.
- Conduct regularly scheduled meetings with clinical and compliance teams across campuses; travel to various sites as required to foster a culture of compliance and deliver hands-on support.
3. Training & Education
- Oversee the design, development, and ongoing evaluation of compliance education programs covering fraud and abuse, billing and coding accuracy, and related regulatory topics.
- Direct clinical compliance training initiatives for all employees, volunteers, medical and professional staff, contractors, business associates, alliances, and other third parties as applicable.
- Leverage technology, e-learning platforms, artificial intelligence and data analytics to expand training reach and measure comprehension and completion across the organization.
4. Policy & Procedure Development
- Oversee the creation, implementation, and ongoing review of institutional compliance policies and procedures to ensure alignment with applicable federal and state regulations, accreditation standards, and organizational values.
- Monitor regulatory developments and initiate timely policy updates to address changes in Medicare, Medicaid, commercial payor requirements, or applicable state law.
5. Auditing, Monitoring & Risk Assessment
- Oversee the development and execution of an annual clinical compliance audit and review schedule, informed by institutional and enterprise risk assessments, data mining tools, artificial intelligence, and known industry risk areas.
- Perform and supervise regular internal audits of billing, coding, and clinical documentation for accuracy, completeness, and regulatory compliance.
- Investigate compliance incidents and potential violations; develop corrective action plans and oversee remediation activities to closure.
- Collaborate with data analytics and informatics teams to leverage data mining and AI-driven tools to identify billing anomalies, utilization outliers, and emerging compliance risks.
6. Regulatory & Governmental Affairs
- Assist the CRCO in managing interactions with the OIG, CMS, DOJ, and other federal and state regulatory bodies, including voluntary disclosures, audits, investigations, and inquiries.
- Support the investigation and formal response to complaints or inquiries received from governmental enforcement agencies, accreditation bodies, and commercial payors.
- Maintain expertise in False Claims Act enforcement, Anti-Kickback Statute, Stark Law, HIPAA/HITECH, and other laws and regulations applicable to academic medical centers and health systems.
- Serve as an institutional resource for compliance with CMS, OIG Work Plan priorities, and state regulatory requirements.
Required QualificationsBachelor's degree required. Seven years progressively responsible management experience required. Education beyond bachelor's level may substitute for required experience on a year-for-year basis.
To apply, please visit: https://sjobs.brassring.com/TGnewUI/Search/home/HomeWithPreLoad?partnerid=25898&siteid=5283&PageType=JobDetails&jobid=911709All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, genetic information or status as a protected veteran.
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