Join the World's Top Legal Talent Network

Inovalon was founded in 1998 on the belief that technology, and data specifically, would empower the transformation of the entire healthcare ecosystem for the better, improving both outcomes and economics. At Inovalon, we believe that when our customers are successful in their missions, healthcare improves. Therefore, we focus on empowering them with data-driven solutions. And the momentum is building.

Together, as ONE Inovalon, we are a united force delivering solutions that address healthcare’s greatest needs. Through our mission-based culture of inclusion and innovation, our organization brings value not just to our customers, but to the millions of patients and members they serve.

Overview: The Senior Director, Compliance is responsible for the execution and management of ComplexCare Solutions’ compliance, privacy and delegation oversight functions. This role will also provide advice on a range of healthcare compliance matters, including regulatory, third-party risk, practitioner credentialing and compliance audit requirements. The incumbent will further support compliance requirements and risk-based strategies to advance product development, business expansion and growth initiatives.

Duties and Responsibilities:

• Manage the day-to-day operations of ComplexCare Solutions’ Corporate Compliance and Privacy program to include regulatory compliance topics, customer audit responses, management of attestations and complaint management;
• Direct and lead the delegation oversight function which includes ensuring that delegates are meeting contractual obligations and compliance with Centers for Medicare and Medicaid Services (CMS) regulations, National Committee for Quality Assurance (NCQA) standards and other relevant policy;
• Oversee the coordination and implementation of client corrective action plans;
• Investigate and manage compliance and privacy concerns raised through ComplexCare Solutions’ Compliance Hotline and other reporting channels, and implement resolution strategies;
• Manage periodic privacy and compliance risk assessments, including mitigation and remediation efforts;
• Lead the enterprise-wide provider credentialing functioning;
• Conduct annual reviews of compliance policies, the Code of Conduct and implement necessary revisions;
• Collect and analyze data for compliance data requests and recurring dashboards and scorecards.
• Complete customer and vendor questionnaires regarding the Company’s policies
• Lead ComplexCare Solutions’ compliance training strategy and develop/implement related materials;
• Represent Complex Care Solutions on client calls and other audit, delegation and credentialing meetings;
• Maintain compliance with Complex Care Solutions’ policies, procedures and mission statement;
• Adhere to all confidentiality and HIPAA requirements as outlined within Complex Care Solutions’ Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;
• Fulfill those responsibilities and/or duties that may be reasonably provided by Complex Care Solutions for the purpose of achieving operational and financial success of the Company; and
• Other duties as assigned.

Job Requirements:

• Minimum of nine (9) years of prior compliance experience which may include healthcare regulatory, risk assessment and audit experience;
• Minimum of five (5) years of prior experience managing teams and direct reports;
• Working knowledge of key laws and regulations that apply to provider compliance, including Anti-Kickback Statute and Medicare and Medicaid program requirements;
• Prior work experience in the healthcare industry is preferred;
• Knowledge and direct experience with CMS compliance program requirements;
• Knowledge of state and federal regulatory bodies such as CMS and NCQA;
• Compliance experience in risk adjustment is a plus;
• Must excel in fast-paced environment with a broad set of diverse stakeholders;
• Highly professional demeanor, communication style and approach, analytical and critical decision-making, investigational skills;
• Effective verbal and written communication skills and interpersonal skills with the ability to effectively listen and communicate to varied levels; and
• Strong problem solving, risk analysis and project management skills and the ability to work with minimal supervision.

Education:

• Bachelor’s Degree or equivalent work experience required; and
• Compliance related certification preferred.

Physical Demands and Work Environment:

• Sedentary work (i.e., sitting for long periods of time);
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force;
• Frequently or constantly to lift, carry push, pull or otherwise move objects and repetitive motions;
• Subject to inside environmental conditions; and
• Up to approximately 10% travel may be required.

_The actual base pay offered may vary depending on multiple factors including, but not limited to, job-related knowledge/skills, experience, business needs, geographical location, and internal equity. At Inovalon, it is not typical for an individual to be hired at or near the top end of the range for their role, and compensation decisions are dependent upon the facts and circumstances of each position and candidate.

_ Base Compensation Range

$145,100—$170,000 USD

_Studies have shown that women and people of color are less likely to apply for jobs unless they believe they meet every one of the qualifications listed in a job description. If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply regardless. Inovalon is most interested in finding the best candidate for the job and you may be just the right person for this or other roles.

_ _By embracing diversity, equity and inclusion we enhance our work environment and drive business success. Inovalon strives to reflect the diversity of the communities where we operate and of our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

_ _Inovalon is proud to be an equal opportunity workplace and is an affirmative action employer. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

_ _The Company maintains a drug free work environment for all of its associates, which includes employees, contractors and vendors. It is unlawful for associates to manufacture, sell, distribute, dispense, possess or use any controlled substance or marijuana in the workplace and doing so will result in disciplinary action, up to and including termination of employment or the contracted relationship.

_ To review the legal requirements, including all labor law posters, please visit this link