Director, Business Compliance (Coding & Risk Stratification)

Aledade's Compliance & Ethics organization is searching for an experienced, data-driven healthcare compliance leader. This critical role will use innovative, technology-driven solutions to improve patient outcomes while ensuring compliance with regulatory and ethical standards. The Business Compliance Director will proactively ensure Aledade adheres to relevant laws, regulations, and internal policies. This will be achieved by working closely with Aledade’s Legal-Regulatory team to provide compliance support for all new and ongoing programs and business initiatives, synthesizing complex regulatory requirements, and providing the business with actionable compliance requirements. This position will help the business teams operationalize regulatory and contractual requirements in order to meet business objectives. 

• Lead the Coding, Risk Stratification, and Billing Compliance Sub-Committee, including an Overpayments Program.
• Govern the Practice Partnership Integrity Program.
• Develop and implement compliance programs and procedures to ensure compliance with all applicable laws, regulations, and internal policies related to value-based care (Medicare Shared Savings Program and Medicare Advantage).
• Provide compliance support for all new and ongoing programs and business initiatives (e.g., Flex Program, Clinically Integrated Networks).
• Primary compliance point of contact for Product and Technology teams.
• Identify and assess compliance risks and develop mitigation strategies.
• Provide Compliance training and education.
• Stay up-to-date on changes in laws, regulations, and internal policies.
• Work closely with other Aledade departments to ensure compliance with all applicable laws, regulations, and internal policies.

• Bachelor's degree.
• 10+ years of work experience, ideally in the healthcare industry
• 7 years of experience in healthcare compliance, and a minimum 5 years of experience in coding and billing compliance.
• Strong understanding of healthcare regulations, including HIPAA, Stark Law, Anti-Kickback Statute, and other relevant regulations. 
• Excellent communication and interpersonal skills, with the ability to present complex information clearly and concisely.
• Ability to work independently and as part of a team.
• Strong analytical and problem-solving skills.

• Juris Doctor (JD).
• Certified in Healthcare Compliance.
• Experience in value-based care healthcare delivery model.
• Experience chairing/leading compliance committees.
• Experience presenting and reporting to the Board of Directors.

Who We Are:

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

What Does This Mean for You?

At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.

In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:

Flexible work schedules and the ability to work remotely are available for many roles

Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners

Robust time-off plan (21 days of PTO in your first year)

Two paid volunteer days and 11 paid holidays

12 weeks paid parental leave for all new parents

Six weeks paid sabbatical after six years of service

Educational Assistant Program and Clinical Employee Reimbursement Program

401(k) with up to 4% match

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And much more!

At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.

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