Summary/Objective: Leads and oversees NorthStar’s compliance investigation’s function, ensuring investigations are objective, timely, consistent, and well-documented, in accordance with state and federal laws, regulations, payer expectations, and organizational policies. Strong contributor to a best-in-class compliance and privacy program.
*This position offers a hybrid work arrangement, combining remote flexibility with on-site presence at our Irving, TX office two days per week.
Essential Functions:
- Responsible for the compliance investigation’s function, including case intake of inquiries and allegations, triage, prioritization, investigation planning, documentation standards and review, resolution, report writing, follow-up and closure.
- Conducts interviews, gathers and reviews relevant documentation, prepares investigative reports, action plans, and follow up.
- Support compliance program staff by providing consultation on investigative strategy and execute consistent investigation practices.
- Responsible for the preservation and investigation recordkeeping activities are performed including appropriate documentation, investigative records, analysis, and close out of all investigations in shared files and case management system.
- Evaluate and escalate allegations involving healthcare laws, regulations, payer requirements, organizational policies, privacy and security obligations, billing practices, fraud, waste and abuse, and standards of ethical conduct.
- Conduct annual compliance program awareness survey and report results as well as implement any corrective actions identified in data analysis.
- Responsible for partnering with relevant departments to ensure investigations are appropriately coordinated, resolved, and tracked.
- Recommend policy updates, education, monitoring, repayment review, disciplinary referral, or process improvements.
- Maintain and monitor investigation metrics, timelines, outcomes, and corrective action plans to support leadership reporting and oversight.
- Synthesize complex information, perform root cause analysis, identify compliance issues and trends, translate findings into practical risk mitigation strategies that may include auditing recommendations, monitoring, education, and/or practical risk mitigation priorities.
- Support compliance program governance by preparing investigation summaries, trend reports, and recommendations for senior leadership, compliance committees, and other oversight forums.
- Maintain current knowledge of applicable healthcare compliance requirements, including HIPAA, fraud, waste and abuse standards, federal and state healthcare program rules, and internal policies.
Qualifications:
- Bachelor’s degree in Business, Healthcare Administration, or related field of study.
- Experience in conducting investigations in a hospital, health system, physician group, or other regulated healthcare environment required, as well as competency in Healthcare Compliance required.
- 2+ years of supervisory, team lead, project lead, or case management experience, preferably in a healthcare compliance or investigations environment
- Professional certification in either healthcare compliance or investigations is required.
- Use compliance case management systems, audit tools, electronic health records, claims data, reporting dashboards, and data analytics.
- Knowledge of compliance risk assessment, corrective action planning, monitoring, reporting, and governance practices.
Knowledge, Skills and Abilities:
- Strong judgment and objectivity when assessing sensitive matters.
- Excellent interviewing, listening, and fact-gathering skills.
- Strong written communication skills with the ability to produce clear, organized reports.
- High attention to detail and ability to manage complex information with discretion and professionalism.
- Expertise in Microsoft Office applications, including Excel, Word, and PowerPoint.
- Current knowledge of applicable federal and state healthcare regulations.
- Knowledge of compliance program requirements and procedures.
- Strong critical thinking and analytical skills.
- Excellent verbal, written, and presentation skills.
- Strong organizational and planning skills with the ability to manage competing priorities.
- Ability to maintain strict standards of confidentiality and ethical conduct.
- Demonstrate analytical rigor, create reports, dashboards, graphs and charts as required
Competencies:
- Oral and Written Communication with internal and external clients
- Problem Solving/Analysis
- Initiative
- Thoroughness
- Teamwork Orientation
- Time Management
- Follow-up
- Technical/Professional Knowledge and Skills
- Work Standards