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Willingly and effectively cooperates with Bancroft NeuroHealth, The Department of Human Services, The Division of Developmental Disabilities (DDD), and other licensing or state agency or local municipalities in any inspections and investigations, upon request.
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The Director, Compliance Investigations is responsible for developing and maintaining a comprehensive compliance investigation program, including managing the company’s confidential ethics and compliance hotline, conducting investigations into potential compliance violations, performing root cause analysis to address compliance deficiencies, implementing corrective actions to mitigate risk, and providing guidance and reporting to stakeholders throughout the organization.
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With support from Legal department, lead internal investigations related to the compliance program and if required, implementation of applicable corrective and preventative measures and reporting to relevant government agencies.
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Conduct vulnerability investigations and mitigations on network infrastructure to ensure compliance with PCI, HIPAA, and other regulations. Reporting to the Client Delivery Executive with guidance from the Infrastructure Project Manager, the Network Engineer assumes responsibility for network installation planning, upgrades, cutovers, and testing.
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N.J. Department of Education Administrative Code and Amendments, Commission of Accreditation of Rehabilitation Facilities (CARF), Joint Commission for the Accreditation of Healthcare Organization (JCAHO) Division of Youth Services (DYFS) where applicable, the Individual Program Plan (IPP), Health Insurance Portability & Accountability Act (HIPAA), and established Bancroft policies and procedures.
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Direct the company's confidential Ethics & Compliance Hotline including intake, case management workflow, reporting, analytics and managing relationships with outside vendor partners. In-depth knowledge of healthcare laws and regulations, with specific expertise in compliance requirements related to billing and coding, privacy and security, and fraud, waste and abuse, including but not limited to HIPAA, Anti-Kickback, Stark, Medicare/Medicaid reimbursement.
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Maintain a thorough understanding of relevant healthcare laws and regulations, including but not limited to HIPAA, Stark Law, Anti-Kickback Statute, and False Claims Act, and ensure that investigative practices remain current and compliant.
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Develop and manage relationships with external partners, such as regulatory agencies, law enforcement, legal counsel and professional services organizations to facilitate collaboration and information sharing related to compliance matters and investigations.
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Strong investigative experience: proven analytical skills, judgement and attention to detail, with the ability to conduct thorough, objective and complex investigations, analyze complex data sets, and draw actionable conclusions.
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Lead and oversee investigations into allegations of fraud, waste, abuse, and other compliance concerns, ensuring thorough and objective analysis of evidence and documentation. At minimum 8-10 years of progressive experience in healthcare compliance or comparable risk management capacity, including at least 3-5 years in a leadership or management role overseeing and conducting investigations.
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Intermediate to Advanced proficiency in Microsoft Office Suite and experience with compliance software, case management systems and data analytics and reporting tools. Assessing the effectiveness of Company's compliance program and with specific compliance matters and investigations.
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Assists Compliance leadership with the deployment and overall operation of the Company's compliance program, including but not limited to the Annual Compliance & Privacy Work Plan, including assessing the effectiveness of Company's compliance program and with specific compliance matters and investigations and.
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Experience supporting leadership with development of annual workplans, budgets resource planning and reporting. Manages and provides oversight of documentation in and reporting from databases with reported matters used by the department.
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Advanced degree (e.g., JD, MBA, MPH) or clinical certification. Certifications in investigation, interview, and/or fraud examiner techniques. Bachelor's degree required, preferred in healthcare administration, business administration, legal or justice studies, or related field.
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With the nation's largest home infusion provider, there is no limit to the growth of your career. Experience representing a company and interacting with senior level management, legal counsel, federal and state regulators and law enforcement on compliance and privacy matters.
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hipaa investigations reporting jobs
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