Director of Compliance
- 🇺🇸 United States
- Hybrid
- Manager or above
- 1 day ago
- CPT
- ICD-10
- HIPAA
- OSHA
- infection control
- Equity
- Pension
The Opportunity
We're looking for a Director of Compliance to lead and mature our enterprise compliance program across a complex, fast-growing, multi-state footprint. This person will own the day-to-day operation of the compliance program and serve as a trusted advisor to executive leadership, operations, revenue cycle, and affiliated clinicians. The ideal candidate combines deep knowledge of healthcare regulation with practical judgment. They know when to escalate and when to solve, and they can operate a program that protects the organization without slowing it down.
This is a high-visibility role with direct access to senior leadership and the Board's compliance committee, and a real opportunity to shape the program's next stage of growth.
Key Responsibilities
Compliance Program Leadership
- Implement, and continuously improve an enterprise compliance program aligned with the OIG's General Compliance Program Guidance and the seven elements of an effective compliance program.
- Develop and maintain the annual compliance work plan and risk assessment, prioritizing auditing and monitoring based on regulatory, payer, and operational risk.
- Prepare and present regular compliance reports to the Compliance Committee.
- Draft, update, and roll out compliance policies and procedures across all affiliated practices and the support center.
Billing, Coding, and Payer Compliance
- Oversee audits of dental (CDT) and medical (CPT/ICD-10) coding, documentation, and billing practices.
- Assist with responses to payer audits, records requests, and inquiries from commercial payers, Medicaid, and Medicaid managed care organizations.
- Oversee overpayment identification, quantification, and timely refund processes.
- Partner with Revenue Cycle on corrective action plans, education, and follow-up audits.
Regulatory and Fraud & Abuse Compliance
- Advise on federal and state fraud and abuse laws, including the Anti-Kickback Statute, Stark Law, the False Claims Act, and state self-referral and fee-splitting laws.
- Work with Legal to keep the DSO model compliant with corporate practice of dentistry and medicine restrictions, protecting clinical independence and appropriate separation of clinical and non-clinical functions.
- Monitor regulatory developments across all operating states and translate changes into actionable guidance for operations.
- Review marketing arrangements, patient financing programs, and promotional activities for regulatory risk.
Privacy and Security
- Oversee the HIPAA Privacy program (directly or alongside the Privacy Officer), including policies, breach risk assessments, notifications, business associate agreements, and patient rights requests.
- Partner with IT and Information Security on HIPAA Security Rule risk analyses and remediation.
- Ensure compliance with applicable state privacy, breach notification, and consumer protection laws.
Clinical Regulatory and Licensure Oversight
- Maintain oversight of state dental board requirements, including provider licensure, anesthesia and sedation permits, facility permits, and scope-of-practice rules for dental auxiliaries.
- Coordinate compliance with OSHA, infection control standards, radiation safety and equipment registration, and DEA controlled substance requirements.
- Oversee monthly exclusion and sanction screening (OIG LEIE, SAM, and state Medicaid exclusion lists) for employees, providers, and vendors.
Investigations, Hotline, and Corrective Action
- Manage the compliance hotline and lead or oversee investigations of reported concerns, documenting findings and corrective actions.
- Coordinate with Legal on privileged investigations, government inquiries, and potential self-disclosures.
- Track corrective action plans through completion and verify their effectiveness.
Training and Culture
- Build and deliver risk-based compliance training for support center staff, practice teams, and clinicians, including onboarding and annual training.
- Foster a speak-up culture by making compliance accessible, practical, and visible at the practice level.
M&A and Integration
- Support due diligence on prospective practice affiliations, identifying billing, licensure, privacy, and regulatory risks.
- Lead the compliance workstream of post-close integration, bringing newly affiliated practices onto company policies, training, and monitoring on a defined timeline.
Requirements
Required
- Bachelor's degree in healthcare administration, business, law, or a related field.
- 5+ years of progressive healthcare compliance experience.
- Demonstrated experience building or managing a compliance program in a healthcare organization (DSO, MSO, physician practice management, or provider group strongly preferred).
- Working knowledge of HIPAA, OSHA, DEA regulations, the Anti-Kickback Statute, the False Claims Act, and Medicaid program integrity requirements.
- Hands-on experience with coding and billing audits, payer audit responses, and overpayment management.
- Proven ability to conduct investigations with sound judgment, discretion, and clear documentation.
- Exceptional written and verbal communication skills, including the ability to explain complex regulatory concepts to clinicians, operators, and executives.
- Comfort working in a fast-paced, growth-oriented, private equity-backed environment.
- Ability to travel up to 25% to affiliated practices.
Preferred
- JD, MHA, MBA, or other advanced degree.
- Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), or equivalent.
- Coding credential such as CPC or Certified Dental Coder (CDC).
- Experience with dental or oral and maxillofacial surgery billing, including medical-dental crossover claims.
- Familiarity with state dental board regulations, sedation and anesthesia permitting, and corporate practice of dentistry restrictions across multiple states.
- Experience supporting compliance diligence and integration in an acquisition-driven platform.
- Experience with compliance management, auditing, or hotline software platforms.
What We Offer
- Competitive base salary, plus annual incentive bonus, and with opportunity for advancement
- Comprehensive medical, dental, and vision coverage
- 401(k) with company match
- Generous paid time off and paid holidays
- Professional development support
- The chance to shape a compliance function at a scaling national organization
US Oral Surgery Management is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law.
Director of Compliance · U.S. Oral Surgery Management