VP, Compliance

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Abby Care

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51 - 200 Mitarbeiter

⚕️ Krankenversicherung

👥 B2C

Healthcare Insurance • B2C

Abby Care ist ein Service, der Familien dabei hilft, für die Pflege von Angehörigen mit Behinderungen oder besonderen Bedürfnissen zu Hause bezahlt zu werden. Die Organisation schult und zertifiziert Familienpfleger kostenlos, verwaltet Einstellung und Gehaltsabrechnung, navigiert durch Medicaid- und Versicherungsunterlagen, um Zahlungen zu sichern, und bietet eine speziell entwickelte Plattform, klinische Unterstützung und Gemeinschaftsressourcen an. Abby Care ist in mehreren US-Bundesstaaten tätig und konzentriert sich darauf, qualitativ hochwertige, vergütete Familienpflege durch Partnerschaften mit Versicherern und Medicaid-Programmen zu ermöglichen.

Beschreibung

• Design, build, deploy, and continuously improve a comprehensive enterprise compliance program covering every aspect of Abby Care's healthcare operations, anchored to the OIG seven-element framework and the DOJ's Evaluation of Corporate Compliance Programs guidance. • Set the company's compliance strategy and priorities, including the annual enterprise risk assessment, multi-year work plan, audit and monitoring calendar, and annual program effectiveness review; secure the resourcing and Board endorsement to execute against them. • Establish and operate the program's full operational backbone — policies and procedures, training and culture, reporting and hotline channels, monitoring and auditing, investigations, discipline, and corrective action — and ensure each element is functioning, measurable, and improving. • Lead compliance across the full program lifecycle, clinical operations, documentation, billing and coding, EVV, payor and MCO contract performance, and program integrity; and work to build a culture of compliance by embedding compliance into how the business runs rather than bolting it on. • Lead regulatory change management across the federal stack (AKS, Stark, FCA, HIPAA/HITECH, CMS, OIG, HRSA, and the 21st Century Cures Act) and across each state Medicaid environment in which we operate. • Manage all government inquiries, audits, investigations, self-disclosures, and any settlement or CIA obligations; serve as the company's principal compliance liaison to regulators, MCO program integrity functions, and external counsel. • Partner with Legal, People, Operations, Clinical Leadership, Information Security, and Finance to embed compliance controls across the workforce, software and vendor ecosystem, and care delivery model. • Partner with the General Counsel on compliance initiatives regarding AI governance and the deployment of AI in clinical and operational workflows, including FDA SaMD/CDS analysis, documentation integrity, and patient-facing disclosures. • Lead compliance diligence and integration for new market entry, new Medicaid program design, new service lines, and M&A activity. • Serve as the company's designated Compliance Officer; chair the Compliance Committee; report regularly to the Board on risk posture, incidents and program effectiveness, with independent access as needed. • Build, hire, and develop a high-performing in-house compliance team, investigations, auditing and monitoring, training, and compliance operations and analytics, and the technology infrastructure that supports a modern program.

🎯 Anforderungen

• 10+ years of progressively senior compliance experience at a healthcare company, including 5+ years at the Director level or above. • A track record of designing and building, or materially rebuilding and scaling, an enterprise compliance program, not solely operating an established one. • Demonstrated end-to-end ownership across all seven OIG compliance program elements, not partial ownership of one or two pillars. • Substantial experience at companies funded by government healthcare programs (Medicaid, Medicaid waivers, Medicare, and managed Medicaid). • Working command of the federal healthcare regulatory stack (AKS, Stark, FCA, HIPAA/HITECH, CMS and OIG guidance) and of state Medicaid program integrity requirements. • Multi-state operating experience and the range to manage a comprehensive, systems-based program across several state Medicaid environments simultaneously. • High judgment on risk tradeoffs, strong written communication, and the credibility to take and defend a position with executives, the Board, and regulators. • Comfort operating in a fast-growth environment with imperfect data, competing priorities, and the need to write the policy yourself before handing it off.

🏖️ Vorteile

• Health insurance • Remote work options • Professional development opportunities