Collective Health

Director, Compliance Programs

Collective Health

full-time

Posted on:

Location Type: Hybrid

Location: San Francisco • Arizona • California • United States

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Salary

💰 $162,500 - $283,250 per year

Job Level

Lead

About the role

  • Provide on-going guidance to the business on claims and compliance-related matters.
  • Act as the primary SME for compliance matters related to claims administration, FWA and billing standards.
  • Develop and oversee the internal auditing and monitoring programs to proactively identify risks.
  • Oversee the response and strategy for client-driven external audits and regulatory inquiries.
  • Collaborate with the Compliance team to create and implement the Annual Risk Assessment and Compliance Work Plan.
  • Support the development and refinement of compliance policies that align with industry benchmarks.
  • Establish and maintain a robust compliance reporting program.
  • Prepare detailed reports and updates for the Compliance Officer to share with the Board of Directors and management.
  • Bridge gap between healthcare claims adjudication workflows, product design and data engineering.

Requirements

  • Minimum of 15 years in healthcare compliance, specifically within a TPA or Health Plan.
  • At least 5 years of experience supervising compliance teams with a focus on coaching and professional development.
  • Proven track record of designing and performing complex compliance audits and investigations.
  • Deep understanding of U.S. healthcare regulations, claims adjudication, and billing standards.
  • Ability to explain the 'how' and 'why' of compliance programs to diverse stakeholders and build strong cross-departmental relationships.
  • Bachelor’s degree required; Masters or Juris Doctorate strongly preferred. CHC certification (or eligibility) is required. RHIA, RHIT, CCS, CPC, CPB, COC, CIC strongly preferred.
Benefits
  • 35,000 stock options
  • Health insurance
  • 401k
  • Paid time off
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
compliance auditsclaims administrationbilling standardsrisk assessmentinternal auditingmonitoring programscompliance reporting
Soft Skills
coachingprofessional developmentstakeholder communicationcross-departmental collaboration
Certifications
CHCRHIARHITCCSCPCCPBCOCCIC