Director of Audit & Compliance

Advocare, LLC is an integrated independent physician owned and governed multi-specialty medical organization which delivers exceptional care throughout New Jersey and Pennsylvania.  It includes pediatricians, family practice physicians and specialists, each of whom has strong bonds with the children, adults, families and communities they serve.  Advocare physicians promise to bring to each patient their vast experience, a pursuit of continuing education and a true love for the practice of medicine.  They are proud to provide the highest quality healthcare with a personal, caring touch which focuses on the health, safety, well-being and overall needs of their patients and their families.  Advocare physicians offer medically integrated excellence for every healthcare need in life.  For more information visit www.advocaredoctors.com.

Reporting to the Vice President of Compliance, Audit, and Privacy, the Director of Audit and Compliance provides auditing and operational compliance support to Advocare, LLC, its Care Centers, physician members and home office team members.  This position is responsible for managing a program within Advocare, LLC to demonstrate a compliance culture through understanding of, and compliance with, federal and state laws and regulations, professional standards, private payor policies and Advocare, LLC's Code of Conduct.  The Director of Audit and Compliance will manage action plans to implement new statutory and regulatory mandates, support the development and execution of annual audit plans, and increase awareness of Compliance and Privacy.  

Responsibilities

• Supports the provision of compliance advisory support and direction for applicable legal and regulatory requirements and mitigate compliance risks;

• Conducts audits, documentation/coding reviews and supplemental analysis in preparation for state and client audits, and assist with the coordination of internal and external audit requests;

• Reviews, evaluates, investigates and resolves compliance and HIPAA privacy issues and concerns to assure compliance with regulatory standards, and applicable laws and regulations;

• Works closely with the Vice President of Compliance, Audit, and Privacy to establish, implement, and maintain policies and procedures addressing areas of significant legal, regulatory or other compliance risks;

• Identifies potential legal and compliance deficiencies and/or compliance/HIPAA privacy risks and recommends mitigating processes designed to achieve adherence;

• Works with the Vice President of Compliance, Audit, and Privacy to implement a strategic and comprehensive privacy program which defines, develops, maintains and implements policies and processes which enable consistent, effective privacy practices to minimize risk and ensure the confidentiality of protected health information (PHI);

• Ensures privacy policies and forms are up to date;

• Serves as a liaison for patient privacy contacts;

• Supports the development and implementation of all HIPAA privacy/compliance training and awareness activities within Advocare, LLC;

• Provides support for all U.S. Department of Health and Human Service's Office for Civil Rights, state regulators and/or other legal or governmental entities in any compliance reviews or investigations;

• Provides guidance in response to documentation, coding, billing, and general compliance inquiries related to pediatric and adult primary and specialty Care Centers;  

• Supports all conflicts of interest related activities, including annual disclosure reviews, investigations and management plans; and

• Fulfills additional assignments and responsibilities as needed.

Qualifications

• Minimum of six (6) years prior corporate compliance, coding, and audit experience;

• Prior work experience in the healthcare industry;

• Compliance related certification preferred (Certification in Healthcare Compliance (CHC); Certification in Healthcare Privacy Compliance (CHPC), Certified Professional Coder (CPC) and/or Certified Compliance and Ethics Professional (CCEP));

• Bachelor's degree required; Master's degree preferred;

• Demonstrated effectiveness operating in complex organizational and regulatory environment;

• Ability to excel in a fast-paced environment with multiple service locations and a broad set of diverse stakeholders, including physician leaders;

• Strong attention to detail and commitment to project ownership, accuracy and completion on a timely basis;

• Excellent analytical skills including the ability to do queries from various software systems (such as the electronic health record and billing systems), compile, analyze and reach conclusions on such data; 

• Experience with monitoring and ensuring compliance with state and federal regulatory requirements and experience in interpreting state and federal laws;

• Professionally skilled in personal presentation, verbal and written communication;

• Strong interpersonal skills with the ability to effectively listen and communicate to varied levels;

• Ability to travel to Care Centers as needed;

• Demonstrated computer skills including Microsoft Office's suite of software applications and remote working platforms such as Zoom, Microsoft Teams and internet software; 

• Experience with eClinicalWorks, Healthicity Compliance Manager, and Meditract, is a plus; and

• Strong problem solving, risk analysis and project management skills and the ability to work with minimal supervision.

Language Ability

Ability to read and interpret documents such as mail, safety rules, operating and maintenance instructions and procedure manuals.  Ability to write reports and correspondence when requested. Ability to speak effectively and clearly to colleagues and visitors.

Reasoning Ability

Ability to solve practical problems and address a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram or schedule form. 

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to an office environment with ringing phones, printing equipment and people moving around.  This role uses standard office equipment.  The noise level in the work environment is usually low to moderate.

This position is a remote position but will require some on-site work (e.g., corporate office meetings, site visits to Care Centers, and other on-site activities) as needed.

Physical Demands

The physical demands described here are representative of those which must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear.  The employee is frequently required to stand, to walk, to use hands to finger, handle or feel and to reach with hands and arms.  

Pre-Employment Screening

Please be aware for the safety and security of our employees and patients all new employees are required to undergo and successfully pass the following:

• Background Check

• Drug Screening

• Exclusion Database Screening

• Reference Check