System Director Revenue Cycle Compliance Govt - Pasadena California

Company: Bileddo Associates
Location: Pasadena, California
Posted On: 05/03/2025

Director, Revenue Cycle Compliance Government

Pasadena CA area
Our client is one of the nations largest not-for-profit health plans, serving 11.8 million members, with headquarters in California. It comprises: Hospitals, Health Plan and Various Physician and outpatient organizations.The Government Reimbursement Compliance Director is responsible for directing the implementation of an effective compliance program to ensure compliance with state and federal laws and regulations, as well as Health Plan and Hospital policies and procedures, relating to risk adjustment, encounter reporting, billing, and reimbursement activities for all lines of business paid by or overseen by the government. This position reports directly to the VP, Government Audit and Reimbursement Compliance Services.The Government Reimbursement Compliance Director supports the enterprise with identifying, investigating, and resolving all compliance matters relating to risk adjustment, encounter reporting, and reimbursement activities for Hospitals and Health Plan.This position is responsible for directing the Government Reimbursement Compliance team. The Director ensures that Government Reimbursement resources are staffed sufficiently and annual work plans managed to effectively address the organization-s government reimbursement compliance priorities and primary risk areas. This requires extensive coordination with the National Finance leaders, as well as the Internal Audit Services department, the NCO senior leadership team, Legal, SOX PMO, and the regional and hospital compliance functions.Experience:

• Minimum five (5) years of management experience.
• Minimum twelve (12) years of compliance-related experience.Education:
  • Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.License, Certification, Registration:
    • N/A.Additional Requirements:
      • Expert knowledge of compliance policies, practices and systems.
      • Develops advanced compliance principles, theories, and concepts.
      • Expert knowledge of compliance-related practices and standards.
      • Project management skills.
      • Must be able to work in a Labor/Management Partnership environment.Preferred Qualifications:
        • Bachelor-s degree in related field (Health Care, Business, etc.) Masters or law degree preferred. Significant revenue cycle compliance experience preferred.
        • 10+ years of escalating managerial work-experience in a highly diversified organization.
        • 5+ years of escalating responsibility and work-experience in compliance field (internal audit, law, etc.); to include progressive management roles in large, complex organization with successive levels of accountability and results.
        • Significant compliance orientation, coupled with business process expertise and acumen. Demonstrated knowledge of current thinking and practice around the business of compliance.
        • Significant knowledge of all pertinent regulatory requirements and compliance program elements.
        • Demonstrated ability to collaborate, communicate and work effectively with senior leadership and a broad cross section of management/leadership from a broad range of functional areas. Demonstrated ability to influence and motivate interdisciplinary teams and individuals who do not report directly to the CCO.
        • Demonstrated strength in organizational development, project management, and strategic planning.
        • Superior communications skills (both oral and written).
        • Demonstrated high ethics and integrity.Our client offers a very aggressive compensation program, relocation and performance bonus programs, great benefits and the unique opportunity to advance your career in ways you may not have imagined, in a location that is extremely desirable!For prompt and confidential consideration, please apply to the following:
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