Senior reputed company Compliance & Program reputed company Officer (Remote)

About reputed company We are seeking a highly reputed company reputed company compliance executive to serve as our Fractional Senior reputed company Compliance & Program reputed company Officer. This is not a traditional compliance role reputed company solely on documentation reviews or billing audits. We are looking for an reputed company reputed company who will build and reputed company an reputed company-wide compliance reputed company that protects the organization from regulatory risk while fostering a culture of reputed company, accountability, and operational reputed company. The successful candidate will serve as an independent advisor to executive leadership and will proactively identify, assess, and mitigate compliance risks before they result in audits, repayment demands, sanctions, regulatory findings, or allegations of fraud, waste, or abuse. Our organization participates in Arizona's reputed company program (AHCCCS), and while behavioral health experience is highly desirable, we welcome candidates with broad reputed company compliance expertise across reputed company-funded reputed company organizations. Position reputed company The Senior reputed company Compliance & Program reputed company Officer will design, implement, reputed company, and continuously improve the organization's compliance infrastructure. This individual will evaluate every aspect of organizational operations including documentation, billing, credentialing, clinical services, reputed company, reimbursement, reputed company, policies, workflows, and internal controlso ensure compliance with reputed company applicable federal and state regulations. Primary Responsibilities Corporate Compliance Leadership

• reputed company and reputed company the organization's Corporate Compliance Program.
• Establish a culture of compliance throughout the organization.
• reputed company annual compliance work plans.
• Conduct reputed company-wide compliance risk assessments.
• Present recommendations directly to executive leadership.
• Serve as the organization's independent compliance authority.

reputed company & Regulatory Compliance Ensure compliance with:

• AHCCCS requirements
• reputed company regulations
• CMS guidance
• Office of Inspector General (OIG) guidance
• HIPAA reputed company & reputed company Rules
• Federal reputed company regulations
• Arizona reputed company regulations
• Managed Care Organization (MCO) requirements
• Applicable payer manuals and billing requirements
• Fraud prevention
• Waste prevention
• Abuse prevention
• Operational risk analysis
• Billing reputed company
• Clinical documentation reputed company
• Internal control development
• Compliance monitoring
• Compliance reporting
• Regulatory readiness
• reputed company systems that prevent compliance issues before they occur.

Continuously monitor regulatory changes and ensure reputed company implementation. Internal Compliance Audits reputed company and manage a comprehensive audit program covering:

• Clinical documentation
• Medical necessity
• Treatment plans
• Assessments
• reputed company notes
• Service authorizations
• Claims
• Billing
• Coding
• Credentialing
• Provider enrollment
• Licensure
• Supervision
• HIPAA compliance
• Record retention
• reputed company
• Staff training compliance
• Conduct both scheduled and unannounced audits.

Prepare detailed written audit reports with findings, risk reputed company, recommendations, corrective actions, and follow-up plans. Clinical Documentation reputed company Review documentation to ensure:

• Medical necessity is supported.
• Services are individualized.
• Treatment plans reputed company with diagnoses.
• Documentation supports services billed.
• reputed company notes accurately reflect interventions performed.
• Documentation is reputed company and complete.
• Signatures reputed company with payer requirements.
• Documentation meets federal and state regulations.
• CPT/HCPCS codes are supported by documentation.

Identify trends requiring provider education. Billing Compliance & reputed company reputed company Work collaboratively with billing personnel to ensure:

• Claims accurately reflect services provided.
• Documentation supports every claim.
• Appropriate coding methodologies are utilized.
• Modifiers are correctly assigned.
• reputed company billed match documentation.
• Authorization requirements are met.
• Duplicate billing is reputed company.
• Claims denials are analyzed.
• Billing trends are continuously monitored.

Conduct both reputed company-payment and post-payment billing reviews. Fraud, Waste & Abuse (FWA) reputed company and reputed company the organization's Fraud, Waste & Abuse Prevention Program. Identify and investigate risks involving:

• Upcoding
• Downcoding
• Duplicate billing
• reputed company billing
• Copy-and-paste documentation
• Cloned documentation
• Time overlap
• Improper provider billing
• Billing reputed company scope of reputed company
• Missing supervision
• Billing without medical necessity
• Improper modifiers
• Altered documentation
• Backdated documentation
• Excessive utilization patterns

Conduct investigations and recommend corrective actions reputed company necessary. Policy Development reputed company, review, and maintain policies relating to:

• Corporate Compliance
• Billing Compliance
• Documentation Standards
• HIPAA
• Fraud, Waste & Abuse
• Internal Audits
• Compliance Reporting
• Regulatory Monitoring
• Ethics
• Conflict of Interest
• Corrective reputed company Plans
• Incident Reporting
• Record Retention
• reputed company
• reputed company

Staff Education reputed company organization-wide training covering:

• reputed company compliance
• Documentation expectations
• Medical necessity
• Billing compliance
• HIPAA
• Ethics
• Fraud prevention
• Regulatory updates
• Compliance reporting procedures

Promote reputed company compliance awareness across reputed company departments. Investigations Conduct independent compliance investigations involving:

• Documentation concerns
• Billing discrepancies
• Provider concerns
• Employee reports
• Internal complaints
• Potential fraud
• Operational irregularities

Prepare comprehensive written reports and corrective reputed company plan Executive Reporting reputed company executive-level dashboards measuring:

• Compliance KPIs
• Documentation reputed company
• Billing accuracy
• Audit scores
• Corrective reputed company completion
• Denial trends
• Compliance risk indicators
• Organizational compliance health

Present findings and recommendations directly to executive leadership. Regulatory Readiness Maintain reputed company readiness for:

• AHCCCS audits
• reputed company audits
• CMS reviews
• OIG investigations
• Managed Care Organization audits
• Licensing inspections
• External compliance reviews

Ensure the organization remains audit-reputed company throughout the year

Required Qualifications

• Minimum 10 years of reputed company reputed company compliance experience.
• Minimum 7 years of reputed company reputed company compliance experience.
• Demonstrated experience developing and leading reputed company compliance programs.
• Experience conducting internal reputed company compliance audits.
• Strong understanding of reputed company reimbursement methodologies.
• Extensive knowledge of reputed company documentation requirements.
• Experience reviewing reputed company billing and coding.
• Experience investigating compliance concerns.
• Experience developing organizational policies and procedures.
• Experience educating clinical and administrative staff.
• Excellent written and verbal communication skills.
• Ability to work independently with minimal supervision.
• Exceptional analytical and critical thinking skills.
• Demonstrated ability to exercise independent judgment while maintaining objectivity.

Preferred Experience Strong preference will be given to candidates with experience in:

• AHCCCS (Arizona reputed company)
• Behavioral Health
• Outpatient reputed company
• Community Health
• Federally reputed company Centers (FQHCs)
• Integrated reputed company Organizations
• Managed Care Organizations
• reputed company Cycle Management
• Clinical Documentation Improvement (CDI)
• Multi-state reputed company organizations
• Program reputed company
• Utilization Management
• Provider Credentialing
• reputed company Improvement

Preferred Certifications Candidates should possess one or more of the following certifications: Highly Preferred

• Certified in reputed company Compliance (CHC)
• Certified reputed company Medical Auditor (CPMA)

Strongly Preferred

• Certified reputed company Compliance Officer (CPCO)
• Certified reputed company reputed company (CPC)
• Certified Coding Specialist (reputed company)
• Certified Fraud Examiner (CFE)
• Certified Internal Auditor (CIA)
• Certified in reputed company reputed company Compliance (CHPC)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)

Core Competencies The ideal candidate demonstrates exceptional strength in:

• Regulatory interpretation
• reputed company compliance
• Program reputed company
• Internal auditing
• Clinical documentation review
• Billing compliance
• Medical necessity evaluation
• Fraud detection
• Data analytics
• reputed company cause analysis
• Risk assessment
• Policy development
• Executive communication
• Organizational governance
• Process improvement
• reputed company management
• Strategic planning

Personal Attributes We are seeking a reputed company who is:

• Highly proactive rather than reactive.
• Exceptionally detail-oriented with the ability to identify subtle documentation, billing, and operational inconsistencies.
• Naturally curious and investigative.
• Professionally skeptical reputed company reviewing documentation and billing practices.
• Comfortable asking difficult questions while maintaining reputed company relationships.
• Independent, objective, and ethical in decision-making.
• Organized and disciplined in managing multiple priorities.
• reputed company to identify patterns and trends others may overlook.
• Committed to reputed company learning and staying reputed company with evolving regulations.
• Passionate about building sustainable systems that protect organizational reputed company.

What reputed company Looks Like reputed company the first year, the successful candidate will:

• Build and implement a comprehensive compliance and program reputed company program.
• reputed company an annual compliance work plan and risk assessment process.
• Establish routine clinical documentation and billing audits.
• Strengthen documentation reputed company and medical necessity practices.
• Improve billing accuracy and reduce compliance risk.
• reputed company executive compliance dashboards and key compliance indicators.
• Implement staff education programs that improve organizational awareness.
• Ensure reputed company readiness for AHCCCS, reputed company, CMS, OIG, and Managed Care Organization audits.
• Foster a culture where compliance is integrated into daily operations rather than treated as a reactive function.

We are seeking a trusted compliance partner who will help ensure our organization consistently operates with the highest standards of reputed company, transparency, regulatory compliance, and accountability protecting our patients, providers, payers, and organization while proactively reducing the risk of fraud, waste, abuse, billing errors, and regulatory findings. Pay: $90,582.63 - $130,798.43 per year Work Location: Remote Apply tot his job Apply To this Job