What are the responsibilities and job description for the Director of Compliance and Risk Management position at Advanced Dermatology and Cosmetic Surgery?
DIRECTOR COMPLIANCE & RISK MGT
Position Summary
The Director, Compliance & Risk Management is a senior leadership role responsible for the day-to-day operation, execution, and continuous improvement of ADCS's enterprise-wide compliance and risk management program. Reporting directly to the General Counsel & Chief Compliance Officer, this role will lead a mature compliance infrastructure supporting a large, multi-state dermatology physician practice with approximately 400 providers and more than 150 clinic locations. The Director will oversee the following compliance related functions: auditing and monitoring, investigations, regulatory and educational training, location site assessments, risk register maintenance, annual Compliance Work Plan execution, committee reporting, policy management, patient discharge oversight, and insurance/risk management coordination. The role requires strategic judgment, operational discipline, and highly effective communication skills, and will have regular interaction with executive leadership, clinical leadership, the Compliance Committee, the Audit & Compliance Committee, and the Board of Directors.
Role Opportunity. This position offers the opportunity to lead and further strengthen an established, high-performing healthcare compliance function. The successful candidate will inherit a formal compliance program with mature governance, strong executive visibility, structured audit and training processes, enterprise risk tracking, and a clear mandate to support ethical, accurate, and compliant operations across the practice.
Key Responsibilities
Enterprise Compliance Program Operations
Required
Position Summary
The Director, Compliance & Risk Management is a senior leadership role responsible for the day-to-day operation, execution, and continuous improvement of ADCS's enterprise-wide compliance and risk management program. Reporting directly to the General Counsel & Chief Compliance Officer, this role will lead a mature compliance infrastructure supporting a large, multi-state dermatology physician practice with approximately 400 providers and more than 150 clinic locations. The Director will oversee the following compliance related functions: auditing and monitoring, investigations, regulatory and educational training, location site assessments, risk register maintenance, annual Compliance Work Plan execution, committee reporting, policy management, patient discharge oversight, and insurance/risk management coordination. The role requires strategic judgment, operational discipline, and highly effective communication skills, and will have regular interaction with executive leadership, clinical leadership, the Compliance Committee, the Audit & Compliance Committee, and the Board of Directors.
Role Opportunity. This position offers the opportunity to lead and further strengthen an established, high-performing healthcare compliance function. The successful candidate will inherit a formal compliance program with mature governance, strong executive visibility, structured audit and training processes, enterprise risk tracking, and a clear mandate to support ethical, accurate, and compliant operations across the practice.
Key Responsibilities
Enterprise Compliance Program Operations
- Lead the day-to-day implementation, operation, and continuous improvement of the enterprise compliance and risk management program under the oversight of the GC & CCO.
- Ensure consistent implementation and operationalization of up to date compliance policies, procedures, and standards across clinical, operational, administrative, and revenue cycle functions.
- Serve as the primary operational escalation point for complex, sensitive, or high-risk compliance matters.
- Monitor daily compliance activities to identify emerging risks, recurring trends, and urgent matters requiring leadership attention.
- Provide practical compliance guidance to leaders, department managers, clinicians, and staff regarding regulatory obligations, Company policies, and compliance expectations.
- Chair, prepare agendas, dashboards, minutes, action-item trackers, executive summaries, and presentation materials for the monthly Compliance Committee meeting.
- Support the GC & CCO in preparing and presenting quarterly Audit & Compliance Committee materials and annual Board compliance reporting.
- Prepare and, as requested, present compliance updates, investigation summaries, risk trends, Work Plan status, and mitigation recommendations to executive leadership and governance committees.
- Ensure timely follow-up and tracking of Compliance Committee, Audit & Compliance Committee, and Board action items.
- Promote a transparent governance structure in which compliance issues are reported, tracked, remediated, and escalated appropriately.
- Plan, prepare and chair monthly compliance department meetings with the GC&CCO, Quality Manager, Audit Manager, Legal Department Paralegal, Compliance Coding Auditors, and Medical Records.
- Attend and participate in the monthly Revenue Integrity Committee meetings.
- Lead the annual compliance risk assessment process, including structured meetings with business departments to identify regulatory, operational, clinical, billing, documentation, privacy, patient safety, reputational, and enterprise-wide risks.
- Maintain, audit, and further develop the Compliance Risk Register, including risk identification, scoring, ownership assignment, mitigation planning, and closure tracking.
- Develop, manage, and execute the annual Compliance Work Plan, ensuring alignment with OIG compliance program guidance, enterprise-wide risk priorities, prior-year findings, audits, investigations, and regulatory developments.
- Review open Work Plan items regularly, assess progress, identify barriers, adjust timelines, and coordinate with responsible departments to drive targeted completion thresholds.
- Analyze recurring risks and emerging health care compliance trends to inform strategic compliance priorities and resource allocation.
- Oversee clinical auditing and monitoring activities, including clinician documentation and coding reviews, provider scorecards, probe audits, corrective action plans, and follow-up education.
- Partner with the Audit Manager, Compliance Coding Auditors, Revenue Cycle, Legal, Clinical Operations, and Coding Education to identify and address documentation, coding, billing, and medical necessity risks.
- Ensure audit activity addresses both compliance risk and revenue integrity, including upcoding, downcoding, insufficient documentation, modifier usage, incident-to concerns, payer requirements, and identified CMS risk areas.
- Coordinate or support overpayment analysis, disclosures, refunds, and remediation when indicated.
- Use audit findings to identify education opportunities, policy gaps, recurring provider issues, or operational barriers requiring corrective action.
- Oversee compliance support for MIPS/MACRA documentation, reporting, audit, and education functions.
- Work with the Quality Manager to monitor provider-level and State professional corporation-level performance, support accurate submissions, and help maintain the highest achievable CMS reimbursement levels.
- Ensure providers and teams with identified MIPS/MACRA documentation gaps receive timely education, follow-up, and corrective action support.
- Escalate broader documentation or coding concerns identified through MIPS/MACRA audits to the Audit Manager or Director of Coding & Education as appropriate.
- Use MIPS/MACRA results and documentation trends to inform training, auditing, and Work Plan priorities.
- Oversee the Company’s customized iAuditor/SafetyCulture clinic assessment program, including weekly and monthly operational mini-audits and comprehensive Compliance Department assessments at each clinic location at least once every two years.
- Ensure clinic assessments evaluate applicable operational, documentation, HIPAA, OSHA, CLIA, medication management, office posting, safety, and Company policy requirements.
- Review deficiency reports, corrective action plans, reassessments, and recurring trends to ensure issues are corrected and closure is documented.
- Coordinate with operational leadership to address barriers to remediation and reinforce accountability at the site level.
- Report location assessment performance, systemic deficiencies, and remediation outcomes through the Compliance Committee, Audit and Compliance Committee and other appropriate governance channels.
- Oversee and/or conduct internal compliance investigations, including matters involving complex facts, multi-day reviews, privacy concerns, documentation issues, patient complaints, billing concerns, or alleged policy violations.
- Ensure investigative steps, witness interviews, document reviews, findings, conclusions, and corrective actions are appropriately documented and performed at the direction of the GC&CCO.
- Coordinate with Legal, Human Resources, Clinical, Quality, Revenue Cycle, IT, and Operations teams as needed.
- Monitor hotline reports and other compliance communications through resolution, ensuring timely follow-up and appropriate remediation.
- Identify patterns across investigations and use findings to inform training, policy updates, audits, and risk mitigation efforts.
- Oversee the annual compliance education strategy, including Medicare/Medicaid Fraud, Waste and Abuse, HIPAA privacy and security, OSHA, and dermatology-specific compliance modules.
- Monitor completion of mandatory training for all employees, clinicians, and executive leadership, and ensure appropriate escalation for non-compliance.
- Support annual Code of Conduct review, update, dissemination, and employee attestation through the Learning Management System.
- Develop and distribute Compliance Alerts and targeted communications when changes in law, regulation, payer guidance, Company policy, or identified risk areas affect clinicians, staff, or operations.
- Update training and communication content based on regulatory changes, investigation findings, audit trends, and organizational needs.
- Oversee privacy-related compliance functions, including EHR and practice management system access auditing, HIPAA incident review, minimum necessary compliance, and escalation of potential privacy violations.
- Monitor access auditing results and coordinate appropriate follow-up, including progressive discipline when warranted.
- Supervise centralized handling of subpoenas and institutional medical record requests, including litigation, government, disability, life insurance, and other formal requests routed to Compliance.
- Ensure unusual, sensitive, or high-risk record requests are escalated to Operations, the Audit Manager, the GC & CCO, or other appropriate leaders.
- Oversee tracking of production, invoices, payments, and records retrieval fee collections where applicable.
- Responsible for tracking and regulatory reporting of HIPAA privacy incidents, including annual OCR reporting for smaller breaches and special or expedited OCR reporting for larger breach events.
- Coordinate with Legal, Privacy, IT, Operations, outside counsel, and business partners to ensure timely investigation, remediation, patient notification, and regulatory reporting consistent with HIPAA, HITECH, and applicable state privacy laws.
- Oversee the operational administration of the Company Policy Committee and the annual review of Company policies as part of the Compliance Work Plan.
- Coordinate with senior leaders and policy owners to ensure policies are reviewed, updated, retired, or escalated as appropriate.
- Maintain the SharePoint-based policy management process, including reminders, review tracking, approval documentation, and policy accessibility.
- Ensure policy revisions are informed by operational subject-matter expertise and aligned with legal, regulatory, and compliance requirements.
- Report policy review progress and significant policy issues to the Compliance Committee.
- Support the Quality Assurance & Peer Review Committee by coordinating compliance-referred quality concerns, patient safety matters, documentation concerns, corrective action plans, and follow-up reporting.
- Work with the Chief Medical Officer, clinical leaders, the GC&CCO, and Compliance to ensure peer review matters are appropriately routed, documented, and reported through proper governance channels.
- Monitor quality-related issues reported to Compliance and coordinate follow-up with clinical and operational stakeholders.
- Ensure compliance issues involving documentation, medical necessity, patient experience, or patient safety are appropriately escalated and remediated.
- Support confidential handling of quality and peer review matters consistent with applicable privilege and confidentiality protections.
- Review and coordinate compliance involvement in patient discharge requests, disruptive patient matters, and other sensitive patient-related concerns.
- Coordinate with clinical, legal, and administrative teams to ensure patient discharge decisions comply with applicable state requirements, Company policy, patient abandonment considerations, and continuity-of-care expectations.
- Draft or review patient discharge communications and maintain documentation of compliance review and approvals.
- Ensure patient discharge matters are handled in a manner that protects staff and the practice while respecting patient rights and access to necessary follow-up care.
- Coordinate annual insurance placement support for professional liability, general liability, D&O, cyber, property, umbrella/excess, workers’ compensation, employment practices liability, and other coverage lines.
- Serve as a primary operational contact with brokers to coordinate applications, data requests, claims history, exposure information, COIs, and renewal materials.
- Support competitive bid review for major coverages and assist in preparing recommendations for the Executive Leadership Team.
- Coordinate with departments to collect complete and accurate renewal information, including statements of value, employee data, claims information, provider counts, location data, and other required submissions.
- Use claims history, loss trends, and enterprise risk considerations to support strategic insurance and risk management recommendations.
- Conduct or support an annual evaluation of the compliance program’s effectiveness, including assessment of policies, procedures, reporting mechanisms, training, auditing, investigations, and governance reporting.
- Identify program gaps, regulatory changes, operational risks, and opportunities for enhancement.
- Prepare annual compliance summaries, risk assessments, and strategic recommendations for executive leadership, the Compliance Committee, the Audit & Compliance Committee, and the Board as directed by the GC & CCO.
- Promote a culture of integrity, accountability, continuous improvement, and practical compliance across the organization.
Required
- Bachelor’s degree required; JD, MHA, MPH, MBA, nursing, coding, or other relevant advanced credential preferred.
- Minimum 5-10 years of progressive healthcare compliance, risk management, audit, privacy, revenue integrity, or physician practice operations experience.
- Demonstrated experience leading or materially supporting an enterprise compliance program in a multi-site healthcare environment.
- Strong working knowledge of OIG compliance program expectations, CMS billing and documentation principles, HIPAA/privacy requirements, exclusion screening, investigations, corrective action plans, and healthcare compliance training.
- Experience preparing executive-level reports, dashboards, committee materials, and Board-facing summaries.
- Proven ability to work effectively with physicians, advanced practice providers, executive leadership, operations, revenue cycle, HR, IT, and legal.
- Experience in a large physician group, dermatology, multispecialty practice, MSO/friendly-PC structure, ambulatory care platform, or private equity-backed healthcare organization.
- Experience with provider documentation audits, MIPS/MACRA, CLIA, OSHA healthcare safety, peer review processes, payer audits, overpayment analysis, and enterprise risk assessments.
- Certification in Healthcare Compliance (CHC), Certified Professional Coder (CPC), Certified in Healthcare Privacy Compliance (CHPC), Certified Internal Auditor (CIA), or similar credential preferred.
- Experience using or managing compliance technology platforms, learning management systems, policy management systems, access-monitoring tools, audit platforms, or risk registers.
- Strategic compliance judgment and practical operational execution
- Healthcare regulatory interpretation and risk assessment
- Investigation leadership, documentation, and issue resolution
- Executive communication and Board-level reporting support
- Ability to influence cross-functional teams without direct authority
- Physician and clinician communication skills, including credibility with providers
- Project management, follow-through, and accountability for open items
- High integrity, discretion, confidentiality, and sound decision-making
- Comfort operating in a fast-paced, multi-state, multi-site healthcare environment