Compliance & Integrity Director

ChenMed LLC; United States; On-site; USD 140,000 - 200,000; Full time

Job summary

ChenMed LLC is seeking a senior compliance and audit leader to design and maintain a risk-based audit program aligned with CMS and HIPAA requirements. You will lead the Coding Audit team, drive continuous improvement, and develop staff in an increasingly data-driven environment.

Responsibilities include conducting privacy/security audits, collaborating across IT, Legal, and Operations, and presenting findings to executive stakeholders. Strong communication and leadership are essential.

Qualifications

• Master's degree in MBA, MHA, Health Informatics, Law (JD) or equivalent; or bachelor's with substantial healthcare compliance experience.
• Minimum seven years in healthcare compliance, auditing, or risk management.
• Certification in HC compliance (CHC) or CPMA or CPC or AHIMA/AAPC equivalent required.
• Licensed attorney with healthcare compliance focus preferred or required in some cases.

Responsibilities

• Design, implement, and maintain a risk-based audit and monitoring program aligned with CMS requirements, OIG guidance, and HIPAA.
• Conduct periodic HIPAA privacy and security audits; collaborate with IT and Legal to remediate PHI vulnerabilities.
• Prepare clear audit reports; present findings to Compliance leadership and stakeholders; drive corrective actions and training.
• Lead and scale the Coding Audit function; leverage AI/data analytics to improve audit efficiency and accuracy.

Skills

Healthcare compliance

Audit program design

Regulatory risk management

HIPAA privacy & security

Data analytics & AI tools

Leadership

Executive communication

Cross-functional collaboration

Education

Master's degree in MBA/MHA/Health Informatics/Law (JD)

Bachelor's with healthcare compliance experience

CHC / CPMA / CPC or AHIMA/AAPC equivalent certification

Licensed attorney for healthcare focus (JD+)

Tools

Audit management software

GRC systems

Microsoft Office Suite (Excel/Word/PowerPoint)

Job description

ESSENTIAL JOB DUTIES/RESPONSIBILITIES

• Audit & Monitoring Program Design and Maintenance – Designs, implements, and maintains a structured audit and monitoring program specific to ChenMed's value-based care model, aligned with CMS requirements, OIG guidance, and applicable federal and state regulations encompassing Risk Adjustment Data Validation (RADV), Medicare Communications & Marketing Guidelines (MCMG), HIPAA Privacy and Security, and other risk areas. Develops and executes a risk-based annual audit work plan. Leads, expands and oversees the Coding Audit team and professional development. Prepares to transition to strategic direction as the function scales while maintaining accountability for audit outcomes.


• HIPAA Privacy and Security Compliance – Conducts periodic audits of privacy and security practices, policies, and controls. Collaborates with IT, Information Security, Operations, and Legal to identify and remediate potential vulnerabilities related to protected health information (PHI). Assists the Compliance & Privacy Officer in breach risk assessments and response activities, as needed.


• Reporting, Collaboration & Continuous Improvement – Maintains accurate documentation and prepares clear, actionable audit reports and presents findings to the Compliance leadership, senior leadership, and relevant stakeholders. Collaborates cross-functionally to drive corrective action, conduct compliance gap analyses, and delivers training programs ensuring staff understand regulatory requirements and compliance obligations. Champions the integration of artificial intelligence and data analytics tools to enhance audit efficiency, accuracy, and scope, building team competency in the use of emerging audit technologies, ensuring staff are prepared to work in an increasingly data-driven environment.


• Other duties – Performs other duties as assigned and modified at manager's discretion.

KNOWLEDGE, SKILLS AND ABILITIES

• Expert-level business acuity with advanced understanding of healthcare compliance, audit, and regulatory risk management frameworks.


• Demonstrated ability to design and operationalize risk-based audit and monitoring programs in a complex healthcare organization; experience building compliance infrastructure from the ground up, scaling programs during growth, or transforming inherited frameworks.


• Strong analytical, critical thinking, and problem-solving skills.


• Proven leadership ability.


• Excellent written and verbal communication skills, including the ability to present complex findings clearly to executive and clinical audiences.


• High ethical standards, integrity, and the professional courage to raise concerns and enforce standards consistently; demonstrated commitment to operating with accountability.


• Alignment with ChenMed's Core Values of Love, Accountability, and Passion; demonstrated ability to build and lead teams with integrity, hold others accountable to high standards, and drive toward organizational objectives with genuine care for outcomes and people.


• Ability to build collaborative relationships across departments and influence without direct authority.


• Advanced skill in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook; competent in audit management software or GRC systems preferred.


• Ability and willingness to travel locally, regionally, and/or nationally up to 25% of the time.


• Spoken and written fluency in English.


• Additional knowledge that strengthens candidacy: Comprehensive understanding of HIPAA Privacy and Security Rules, MCMG requirements, and federal healthcare fraud, waste, and abuse laws (Anti-Kickback Statute, False Claims Act) and ability to translate into actionable controls and procedures. Ability to leverage data analytics, AI tools, or technology platforms to enhance audit and compliance functions.

EDUCATION AND EXPERIENCE CRITERIA

• Master's degree in Business Administration (MBA), Health Care Administration (MHA), Health Informatics, Law (JD), or a related field required; or a Bachelor's degree with substantial additional healthcare compliance or auditing experience may be considered in lieu of the graduate degree on a year-for-year basis.


• A minimum of seven (7) years' progressive work experience in healthcare compliance, healthcare auditing, healthcare regulatory counsel, or related risk management roles required.


• Demonstrated experience in Medicare Advantage compliance, risk adjustment, value-based care regulatory programs; enterprise-scale compliance program design and scaling strongly preferred.


• Experience with AI-assisted audit tools, data analytics platforms, or healthcare compliance technology is a plus.


• Experience conducting attorney-led or privileged assessments and managing workflows; ability to work closely with legal counsel while maintaining privilege a plus.


• Certification (one of the following required): Certified in Healthcare Compliance (CHC) from the Health Care Compliance Association (HCCA), Certified Professional Medical Auditor (CPMA), Certified Professional Coder (CPC), or equivalent healthcare coding and auditing certification from AAPC or AHIMA.


• Licensed Attorney with healthcare compliance, regulatory, or privacy focus (JD + healthcare-specific experience or continuing education).


• Additional credentials that strengthen candidacy: Certified in Healthcare Privacy Compliance (CHPC), Certified in Healthcare Privacy & Security (CHPS), or relevant healthcare privacy law credentials; Artificial Intelligence Professional in Healthcare Compliance (AIP-HC).

PAY RANGE

$140,268 - $200,383 Salary. The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for bonuses or commissions.

EMPLOYEE BENEFITS

https://chenmed.makeityoursource.com/helpful-documents

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.

WHO WE ARE

ChenMed is a family-owned, family-oriented organization committed to bringing superior health care to moderate-to-low-income seniors.

OUR VISION

To positively change American healthcare through primary care innovation for the neediest populations.

OUR MISSION

To provide a convenient, patient-centered environment that fosters enduring relationships between doctors, staff and patients and delivers superior outcomes and a compassionate experience. We will create a healthcare system specifically for our patients' needs through dedicated doctors, a supportive team and customized technology, and achieve value through scalable innovation, resourcefulness and accountability.

OUR PATIENT PROMISE

You are the reason we are here. Your coordinated healthcare and well-being is our focus. Like a member of our family, we will take care of you in good times and in times of need.