Director of Regulatory Compliance and Quality Assurance

The Director of Regulatory Compliance and Quality Assurance is responsible for developing, implementing, and overseeing compliance, HIPAA privacy, and quality assurance programs within the healthcare organization. This role ensures compliance with federal, state, and local regulations, as well as internal policies and procedures. The Director will lead initiatives that promote patient safety, quality care, and organizational integrity. Reports To: Chief of Staff (in the absence of Chief Clinical Operations Officer) Department: Regulatory Compliance and Quality Assurance

Develop and enforce Standard Operating Procedures (SOPs), conduct staff training on compliance, quality assurance, and HIPAA privacy regulations. Investigate complaints and breaches, ensuring corrective actions align with industry standards. Serves as the company’s HIPAA Privacy Officer, overseeing HIPAA compliance, privacy and security practices in collaboration with the HIPAA Security Officer. Conduct regular audits and assessments to identify potential areas of risk and implement corrective action using regulatory documentation tools, as necessary. Serve as the company’s point person in overseeing the Risk Management Committee charter and efforts managing all cross-functional action items. Develop and maintain compliance programs in alignment with CMS/HHS/Medicare/Medicaid, commercial payors, OIG, HIPAA, OSHA, and other regulatory requirements (e.g., Stark Law, Anti-Kickback Statute, Telehealth, etc.). Monitor regulatory and industry developments, updating internal policies and procedures accordingly. Collaborate with operations, development, human resources, legal and compliance teams to stay updated on changes in HR compliance requirements, Medicare/CMS. OIG, and any HIPAA regulations to ensure organizational adherence. Collaborate with various departments to ensure that compliance and quality assurance practices are recognized, prioritized, and integrated into daily operations and workflows. Oversee the Clinical Quality Assurance program, ensuring adherence to state and federal clinical certification requirements, licensure standards, and billing compliance (e.g., “incident to” physician billing). Ensure compliance with payor regulations, medical necessity, guidelines, and coding for CCM/RPM programs. Collaborate with Clinical Operations to monitor payor performance metrics (HEDIS, HCAHPS, MIPS, NCQA, etc.). Act as the primary liaison with regulatory agencies and external auditors, facilitating audits, investigations, and corrective actions, as needed and as directed by Executive Leadership. Prepare and submit required reports to senior management and the board of directors as requested. Promote diversity, equity, and inclusion in the workplace. Other reasonable duties as requested.