Rally Health

Compliance

• Oversee company-wide compliance initiatives related to program administration, focusing on network integrity, quality control, and regulatory adherence (particularly CMS requirements)
• Design and maintain a comprehensive compliance framework aligned with CMS, HIPAA, and internal standards
• Monitor federal and state regulatory changes and translate them into internal policies
• Ensure network partners meet contractual and regulatory obligations; conduct audits of network sufficiency, accessibility, and quality
• Lead CMS audit preparation and response, including CAP submissions and validation audits; maintain CMS documentation and encounter data reporting
• Develop network quality control protocols, identify and mitigate compliance risks
• Draft and enforce compliance policies; partner with Training & Development to deliver role-specific compliance education
• Serve as primary liaison for internal and external audits; provide legal guidance on employment-related matters

Compliance Lead