Director, Compliance

About this role

Thank you for considering a career at Ensemble!
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:

• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.

• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.

• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

The Opportunity:
By embodying our core purpose of customer obsession, new ideas, and driving innovation, and delivering excellence, you will help ensure that every touchpoint is meaningful and contributes to our mission of redefining the possible in healthcare.
Provide Compliance Program leadership for assigned service lines and/or locations, with primary accountability for the oversight of Compliance investigations — ensuring that reported concerns and suspected violations of the Compliance Program are evaluated, investigated, and resolved. This role also serves as a Compliance Liaison to assigned Ensemble clients and/or service lines in accordance with the Compliance Liaison SOP.
II. Job Competencies
Competency Description
Leadership Decision
Making Makes day-to-day leadership decisions by securing and comparing information from multiple sources to identify issues; commits to an action after weighing alternative solutions against important criteria; effectively communicates decisions to the appropriate people and teams and holds them accountable. Drives results.
Delegation Successfully shares authority and responsibilities with others to move decision making and accountability downward through the organization while accomplishing strategic priorities; maintains personal ownership of outcomes without excessive involvement.
Leading Teams Inspires and sustains team unity and engagement by developing, motivating, and guiding the team to achieve results together through productive relationships and work.
Executive
Communication Clearly and succinctly conveys information and ideas; communicates in a focused and compelling way that captures and holds others’ attention (appropriate, impactful, and clear).
Program/Project
Management Demonstrates high accountability and responsibility for projects and programs from inception through completion/implementation; manages budget and resource planning and awareness to ensure maximized output, reduced waste, and exceptional results.
III. Essential Job Functions
Ensemble Difference Principles
• Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.
• Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.
• Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
Compliance Investigations Oversight
Leads Investigations team and personally manages investigations including the following:
• Evaluate and manage compliance concerns and reports of suspected misconduct and perform and oversee investigations to ensure that all suspected violations of the Compliance Program are fully investigated and resolved.
• Oversee the intake, triage, prioritization, and assignment of reported compliance matters, ensuring timely and consistent handling in accordance with Compliance Program requirements.
• Coordinate the implementation of corrective action plans, monitoring progress and completion, and escalating as required — including overseeing complex overpayment/refund activities, claim correction efforts, and the resolution of systemic issues.
• Develop and perform training associated with investigations, government and payer coding audits, and settlements.
• Take, research as needed, and respond to day-to-day compliance questions, including providing effective guidance related to Compliance Program requirements and regulatory risk mitigation.
• Maintain awareness of fraud, waste, and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestically and internationally through personal initiative, continuing education, and peer-to-peer networking.
• Prepare and provide reports of investigation activities, findings, and outcomes as requested by Compliance Leadership.
Compliance Liaison Responsibilities In accordance with the Compliance Liaison SOP, this role also serves as a Compliance Liaison to assigned Ensemble clients and/or service lines:
• Serve as the Compliance Liaison to assigned Ensemble clients and/or service lines, as assigned by leadership.
• Act as the primary compliance point of contact for assigned clients and/or service lines, building trusted relationships with client compliance officers and operational leaders.
• Facilitate timely, two-way communication of compliance matters, regulatory updates, and Compliance Program expectations between Ensemble Compliance and assigned clients and/or service lines.
• Attend and support recurring client and service line compliance meetings and align compliance activity with client-specific policies and requirements.
• Identify,…