Director, Compliance

SUMMARY: The Director, Compliance will be a key member of the Compliance team and assist in the successful implementation and operation of an effective Compliance Program for Baylor Genetics by providing practical advice, resources, and structures to ensure compliance with laws, regulations and Company policies. This person will report to the Sr. Director, Compliance who is seeking someone who proactively shares knowledge, creates self-sufficiency in the team and who can hold staff accountable. 

The successful individual in this role must have a comprehensive understanding of healthcare operations and relevant compliance and privacy regulations and be capable of providing advice and decisions using research-backed data. This person is also expected to adhere to the highest level of personal and professional conduct and possess maturity and engagement skills to interact at all levels of the Company and with external business partners.  This is a get into the weeds position that requires someone collaborative and detail-oriented who can create, implement and operationalize compliance-related procedures, support cross-functional accountability and contribute to a strong culture of compliance in a fast-paced environment. 

DUTIES AND RESPONSIBILITIES:

• Operationalize healthcare regulatory guidance into actionable internal policies and procedures, draft, revise and maintain policies and procedures that reflect current regulatory requirements, operational realities and industry best practices.
• Serve as a key compliance resource to teams across the organization, responding to compliance-related inquiries and providing clear, written actionable guidance on how to apply internal policies and regulatory requirements in day-to-day operations.
• Support the development, implementation and monitoring of compliance education materials; conduct education sessions and help identify opportunities to reinforce policy adoption and awareness across teams.
• Develop and administer Baylor Genetics’ Compliance program through coordination with internal stakeholders, subject matter experts, and best practices.
• Lead the development and execution of Baylor Genetics’ compliance risk assessment and work plan, identify key areas of risk and develop annual audit plan. 
• Conduct and support retrospective and prospective internal compliance audits and spot checks to identify potential gaps or areas of compliance vulnerability.  Collaborate with teams cross-functionally to develop appropriate action plans that address audit findings and introduce controls likely to prevent non-compliance performance.
• Collaborate with internal and external auditors during regulatory audit and monitoring activities.
• Contribute to the preparation and execution of quarterly Compliance Committee meetings, including development of pre-read materials, tracking open issues, and surfacing risk themes or emerging compliance trends for leadership discussion.
• Maintain professional and technical knowledge of healthcare compliance legal and regulatory requirements, including subject matter expertise in Medicare and state Medicaid program requirements, federal/state fraud, waste and abuse laws (e.g. Stark, EKRA, Anti-Kickback) and data privacy regulations.
• Oversee and manage Baylor Genetics’ confidential and anonymous Hotline, to include proper routing of complaints, monitoring and ensuring timely completion of investigations and preparing metric reports for the Compliance Committee and other members management.
• Organize and manage administrative tasks involved in the oversight of key compliance risk areas.
• Oversee and manage exclusion screenings to ensure compliance with regulations and contractual requirements.
• Assists in the development of materials for use in education and communication on Baylor Genetics’ compliance program.  Oversees completion of required compliance education by the workforce.
• Support compliance considerations in product and operational development, partnering with cross-functional teams to ensure new initiatives, workflows or rollouts align with internal policy expectations.
• Perform other duties as assigned/necessary.

EDUCATION/EXPERIENCE:

• Bachelor's degree in Business Administration, Healthcare Administration, or a related field.
• Active compliance and coding certification; CHC, CCEP preferred.
• 10+ years relevant experience, with at least 5 years in the healthcare industry, preferably in a clinical laboratory environment.
• 5+ years experience managing others, preferably in a healthcare compliance setting.
• Adaptable and able to function independently, with little need for oversight, in a fast paced, highly fluid startup environment.

• Ability to timely manage many high-risk, high-pressure projects/issues at once and prioritize effectively based on risk.

• Strong communication skills with proven track record of success working with cross functional teams.
• Working knowledge of applicable regulations and state and federal laws.
• Working knowledge of third-party billing and coding standards for laboratory testing.
• Computer skills and high competence with MS Office (Word, Excel, Powerpoint), LIMS, Salesforce and Epic.

EEOC STATEMENT: We are committed to equal employment opportunities and welcome applications from candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

This job description outlines the responsibilities, qualifications, and EEOC statement pertinent to the Director, Compliance role at Baylor Genetics, emphasizing support for the Compliance and privacy program in compliance with pertinent federal, state, and local regulations.