Director, Regulatory Compliance, Enrollments & Credentialing

Hanger Inc; Colorado; Remote; USD 125,000 - 150,000; Full time

Job summary

An established industry player is seeking a Director of Regulatory Compliance to lead the Regulatory Compliance Enrollments and Credentialing Team. This pivotal role involves ensuring compliance with Medicare/Medicaid regulations, managing enrollment processes, and liaising with state and federal regulators. The ideal candidate will have extensive experience in regulatory environments, exceptional communication skills, and a strong analytical mindset. By fostering collaboration and innovative solutions, you will play a key role in enhancing patient care and operational efficiency. If you're passionate about making a difference in healthcare compliance, this opportunity is for you.

Qualifications

• 8+ years of experience in Medicare/Medicaid enrollment, DMEPOS preferred.
• Demonstrated ability to communicate with and influence regulators.

Responsibilities

• Oversee state DMEPOS licensure, credentialing, and enrollment functions.
• Train staff on new regulations and track implementation as needed.

Skills

Regulatory Compliance

Communication Skills

Analytical Skills

Interpersonal Skills

Problem Solving

Leadership

Education

Bachelor’s degree in business administration or related healthcare field

Tools

MS Office Suite

Various systems and databases

Job description

Why Us:

With a mantra of Empowering Human Potential, Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. Hanger's Patient Care segment is the largest owner and operator of O&P patient care clinics nationwide. Through its Products & Services segment, Hanger distributes branded and private label O&P devices, products and components, and provides rehabilitative solutions to the broader market. With 160 years of clinical excellence and innovation, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value. Collectively, Hanger employees touch thousands of lives each day, helping people achieve new levels of mobility and freedom.

Could This Be For You:

The Director of Regulatory Compliance, Enrollments & Credentialing - Remote is responsible for providing direct strategic and administrative leadership and supervision to the Regulatory Compliance Enrollments and Credentialing Team. Responsible for developing and implementing Hanger Clinic initiatives to monitor compliance with Medicare/Medicaid regulatory requirements related to Hanger Clinic DMEPOS services and enrollments. Supports Medicare/Medicaid Enrollment Team as liaison with state/federal regulators to address areas like: process challenges/denials/corrective action plans. Evaluates staff resource allocation and provides input to senior management on program’s budget needs. Identifies and implements tools for efficient processing, tracking and communication of enrollment statuses, maximizing currently available tools within the Enterprise. Responsible for the supervision of the tracking, completion, and submission of clean Medicare/Medicaid applications based on the needs of Hanger Clinic. Oversees acquisition integration activities for smooth transition of acquired entities into the Hanger ecosystem for continuity of patient care and provision of service.

Performs research on Medicaid requirements and related regulatory requirements. Engages with regulators and serves as management liaison to resolve potential issues. Drafts written responses to regulatory inquiries coordinating submission with Chief Compliance Officer. Partners with Enterprise Compliance and Legal Teams, serving as a liaison for communicating with government agencies to expand departmental efficiencies and validating interpretation of regulatory changes and related implications. Provides expert level consultation on Medicaid and Medicare enrollment requirements and regulations across Hanger, Inc. Consults with field staff on application process for state level Hanger Clinic licenses and Medicaid services. Supports and validates DME/pharmacy licensure requirements and navigates enrollment submissions. Candidate must have excellent presentation and communication skills, ability to represent Hanger at external events (client and national association meeting) and diffuse difficult situations. Must be able to analyze, troubleshoot, support the needs of internal and external customers with a sense of urgency, while maintaining or exceeding established productivity, quality standards, and customer service.

Your Impact:

• Establish, maintain, and oversee state DMEPOS licensure, credentialing and enrollment functions required for compliant billing to all payers such as: Medicare, Medicaid, VA, commercial carriers
• Identify new enrollment requirements in accordance with related regulations impacting on DMEPOS across all 50 states
• Train staff across organization on new regulations and track implementation as needed
• Create processes and tracking mechanisms to identify new regulations impacting on DMEPOS enrollments
• Oversee direct reports to complete Medicare/Medicaid applications/obtain licenses accordingly. Able to complete applications if needed.
• Interpret/analyze regulations and other requirements, in partnership with Legal and Compliance Regulatory teams
• Coordinate directly with regulators to increase efficiency and performance of departmental functions

Minimum Qualifications:

• 8+ years of related experience in multi-site, multi-state Medicare/Medicaid enrollment, DMEPOS preferred
• Bachelor’s degree in business administration or related healthcare field
• 5+ years Supervisory/Management experience
• Demonstrated ability to communicate with and influence regulators
• Knowledge of legislative and regulatory processes and applicable impact on DMEPOS or experience directly within a regulatory agency
• Demonstrated knowledge of current trends and developments in healthcare reimbursement environment
• Demonstrated ability to lead & manage through influence & change
• Strong interpersonal skills emphasizing flexibility and diplomacy
• Must have, or be eligible to obtain, a valid driver’s license and driving record within the standards outlined within Hanger’s Motor Vehicle Safety Policy and Procedures.

Additional Success Factors:

• Proven experience in monitoring and assessing compliance through formal and informal risk assessment processes, identifying gaps and recommending and implementing compliance solutions
• Proven experience in using various systems and databases to conduct research and generate reports
• Highly proficient in MS Office Suite of programs
• Experience in regulatory analysis and advocacy
• Knowledge of legislative and regulatory processes.
• Solid understanding of the U.S. regulatory environment including aging, health, disability
• Knowledge of health care programs and related issues at state and federal levels (such as Medicaid/Medicare/VA)
• Demonstrated knowledge of current trends and developments in healthcare.
• Exceptional presentation and public speaking skills
• Strong analytical and creative problem solving skills
• Ability to prioritize and manage multi-task functions
• Directs and supervises the Regulatory Compliance Enrollment Team
• Employ high level complex analytical thinking that incorporates in depth knowledge of healthcare regulations;
• Ability to clearly communicate complex regulatory information verbally and in writing
• Demonstrate excellent time management, organization, prioritization, research, analytical, negotiation, communication (verbal and written) and interpersonal skills.
• Act with integrity in all ways and at all times, remaining honest, transparent, and respectful in all relationships.
• Keep the patient at the center of everything that you do, building lifelong trust.
• Foster open collaboration and constructive dialogue with everyone around you.
• Continuously innovate new solutions, influencing and responding to change.
• Focus on superior outcomes, and calibrate work processes for outstanding results.