Director of Compliance Risk Managment

Job Description:Job Title: Director of Compliance Risk ManagementLocation: Springfield, MODepartment: Compliance and IntegrityEmployment Type: Full-timeShift: DaysJob Summary: The incumbent strategically identifies and mitigates potential risks associated with Brightli System Members’ participation in the Federal healthcare program. The Director of Compliance Risk Management position offers…

All-Inclusive Employee Benefits Package - A robust full-time employee benefits package encompassing health, dental, vision, retirement, disability, life insurance, wellness program, and more

Telemedicine – 24/7 phone, web, or mobile app medical, behavioral health, & dermatology visits

Employee Assistance Program – 24/7 counseling services, legal assistance, & financial consultation for you and your household at no cost

Paid Time Off - 29 days per year including vacation & holiday pay

Workplace Culture - An environment cultivating employee wellbeing, valuing each individual's humanity, and actively promoting healthy, joyful workforce engagement

Key Responsibilities:

Conduct routine Compliance Risk Assessments with Brightli System Members.

Develop and implement internal audit work plans based on Compliance Risk Assessments and ongoing billing/documentation trends.

Update internal audit work plans regularly based on Compliance Risk Assessments and ongoing billing/documentation trends.

Receive, analyze, and maintain internal and external audit reports.

Oversee the development and maintenance of audit tools.

Administer internal auditing programs per best practices and internal work plans.

Supervise coordination of internal and external audit activities.

Track development and implementation of corrective action plans from audits.

Conduct and direct investigations into suspect billing for Federal health care program overpayments.

Analyze claims data for potential fraud waste, and abuse patterns.

Prepare and present audit activity reports to Compliance Committees and People Leaders.

Provide guidance on coding, billing practices and documentation requirements.

Supervise Lead Compliance Audit Coordinator and train Audit Team Members.

Maintain work papers, files, and documentation per regulatory requirements. Ensure confidentiality of business information, including protected Health Information (PHI), as per HIPAA and company policy. Other duties as assigned.

Experience and/or Education Qualifications:

Bachelor’s degree from an accredited college or university in Health Information Management, Healthcare Compliance or related field required.

At least one of the following credentials (RHIA, RHIT, CHC), required.

Three to five years’ experience in healthcare related compliance, auditing or health information management.

Supervisory Requirements:

Communicate the strategic direction of the organization and encourage participation by all team members.

Provide leadership and guidance to all aspects of the department.

Take an active role in monitoring the identification, development, and execution of strategic objectives.

Involve, as appropriate, all team members to achieve goals.

Effectively communicate to team members any changes and newsworthy events within the department or company.

Handle difficult team member situations directly, using appropriate discretion and Human Resource advice to show respect for the individual

Champion change and effectively manage the implementation of new ideas.

Reinforces team approach throughout functions; support and solicit input from team members at all levels within the company.

We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.Brightli is a Smoke and Tobacco Free Workplace.About BrightliBrightli is on a mission: A mission to improve client care, reduce the financial burden of community mental health centers by sharing resources, a mission to have a larger voice in advocacy to increase access to mental health and substance use care in our communities, and a mission to evolve the behavioral health industry to better meet the needs of our clients. We are doing this by forming a new behavioral health organization under new model. Under one parent company, multiple organizations are able to collaborate, share resources and system supports, increase recruiting and retention efforts, increase access to specialized care, and meet the growing demand for behavioral and addiction recovery care.Brightli’s top-line subsidiaries include Burrell Behavioral Health (Burrell), Preferred Family Healthcare (PFH), Southeast Missouri Behavioral Health (SEMO), Firefly, Adult and Child Health, and Places for People. While these organizations operate independently and are governed by separate board of directors, their operations and services benefit from this model. Alone, organizations may be able to navigate the current tumultuous healthcare environment, but we believe that together we can do so much more than survive. Our communities need us now more than ever, and by working together we are ready to answer their call for years to come.Brightli Snapshot

200 locations

4 states

19 subsidiaries and/or affiliates

5k+ employees