Director of Program Integrity Medicaid HIPAA Healthcare

This role will also require conducting operational audits for healthcare organizations.

• Oversee and manage compliance functions within the healthcare sector.
• Work closely with government healthcare programs to ensure adherence to regulations and standards.
• Demonstrate a strong understanding of Medicaid regulations and apply this knowledge in daily operations.
• Maintain a thorough understanding of HIPAA and other applicable federal and state regulations and ensure compliance across all operations.
• Execute enterprise risk management processes effectively and efficiently.
• Conduct operational audits for healthcare organizations, ensuring all processes meet regulatory standards.
• Utilize knowledge and skills obtained from being a Certified Regulatory Compliance Manager (CRCM) to enhance compliance processes.
• Leverage expertise in Health Care Audits - Medicare - Medicaid to improve operations and compliance.
• Utilize strong understanding of Health & Health Care Law to ensure the organization's operations are within legal boundaries.
• Ensure HIPAA Compliance - Patient Privacy Rule is upheld across all operations.
• A minimum of 10 years of experience in a compliance role, preferably within the healthcare sector
• Demonstrated expertise in Medicaid regulation, Medicaid program and Medicaid application processes
• Solid understanding of Health Care Audits, especially those involving Medicare and Medicaid
• Proven experience in HIPAA Compliance, specifically the Patient Privacy Rule
• Familiarity with HIPAA-regulated procedures and practices
• Knowledge of Health & Health Care Law is essential
• Ability to interpret and implement complex healthcare regulations effectively
• Excellent communication and interpersonal skills to interact with various stakeholders
• Strong analytical skills to identify potential compliance risks and develop mitigation strategies
• Bachelor's degree in law, business administration, healthcare administration, or a related field is preferred. Advanced degrees or compliance certifications would be advantageous.
• High ethical standards and professionalism, with a commitment to confidentiality and integrity.