About the role 

The Compliance & Accreditation Director for Primasun, LLC provides direction and oversight of the Company Compliance Program and is responsible for leading initial and ongoing efforts related to healthcare accreditations for the operations of Primasun's telehealth Sleep Disorder platform. The C&A Director's responsibilities will require identifying and assessing compliance risk areas for the company, and working with cross-functional company leadership to build, monitor and maintain compliant, audit-ready business practices. The C&A Director will need to communicate the importance of the Compliance Program to executive management. Duties will require and are not limited to preparing and distributing the written Code of Conduct setting forth the ethical principles and policies which are the basis of the Compliance Program; developing and implementing education programs addressing compliance and the Code of Conduct; implementing a retaliation-free internal reporting process, including an anonymous reporting system; and collaborating with executive management to incorporate the compliance Program within system operations and programs effectively and to carry out the responsibilities of the position.

This critical member of Primasun’s leadership team will report to the Head of Operations and partner with Operations and other senior leaders to ensure Primasun embeds and adheres to strong healthcare and corporate compliance practices through its compliance program. 

Responsibilities  

• Ensuring that the Compliance Program effectively prevents and detects a violation of law, regulations, Primasun policies, or the Code of Conduct.

• Regularly reviewing the compliance plan and recommending appropriate revisions and modifications, including advising administrative leadership and the Board of Directors, if deemed appropriate, of potential compliance risk areas.

• Coordinating resources to ensure the ongoing effectiveness of the compliance Program.

• Serving as a key point of contact for healthcare regulatory agencies and accreditation bodies to facilitate Primasun’s initial certification / qualification process as well as ongoing audits, recertifications, and requalifications. 

• Advising and assisting the Director of Provider Operations with provider credentialing requirements.

• Implementing and operating protected reporting channels, including an anonymous telephone reporting system available to all Primasun employees, contractors, and affiliated partners.

• Developing education programs for all Primasun employees, contractors, affiliated partners, or others working directly with the Primasun platform.

• Working closely with Primasun Information Technology Department to ensure that internal controls can prevent and detect significant instances or patterns of illegal, unethical, or improper conduct by Primasun employees, agents, affiliated partners, or others working with the Primasun platform.

• Ensuring that the system has effective mechanisms to reasonably determine that a person either promoted to or hired into management and specific other sensitive and responsible positions (to be designated) does not have a propensity to violate federal or state laws and regulations or engage in improper or unethical conduct in their designated areas of responsibility.

• Providing input and direction to Human Resources and Operations policies and procedures and the company’s performance appraisal and incentive programs to ensure that improper conduct is discouraged and that support of and conformity with the compliance program is part of any performance evaluation process for all employees.

• When needed, coordinating as appropriate with outside legal counsel, conducting, authorizing, and overseeing investigations of matters that merit investigation under the Compliance Program.

• With appropriate input from legal counsel, advising and assisting company leadership on contractual issues, to ensure compliant business relationships with all partners.

• Overseeing follow-up and, as applicable, resolving investigations and other issues generated by the Compliance Program, including developing corrective action plans, as needed.

• Tracking all issues referred to the Compliance Office.

• Developing productive working relationships with all levels of management.

• Presenting periodic and annual review reports on the Compliance Program to the Primasun Leadership team and Board of Directors, as appropriate, and implementing approved annual program updates.

• Reporting regularly to executive management on matters involving the compliance program and accreditation progress. Additionally, at their discretion, the C&A Director is expected to report issues to the leadership team and executive officers.

• Working with the leadership team to provide adequate information to employees of Primasun to ensure they have the requisite information and knowledge of regulatory issues and requirements to carry out their responsibilities lawfully and ethically.

• Ensuring that all contracts contain language which is corporate compliant.

• Performing other duties as assigned from time to time by the Head of Operations.

Principal Duties

• Overseeing, coordinating, and monitoring the day-to-day compliance activities of the business unit and the operation of the unit’s Corporate Integrity Program.

• In consultation with the corporate legal team, establishing company compliance policies. Maintaining and supplementing as necessary.

• Establishing, supervising, and training Primasun departments to aid in the identification of compliance issues at the departmental level. Ensuring appropriate communication for compliance issues between departments.

• Developing and coordinating appropriate compliance training and education programs for all employees. Ensuring and understanding Primasun’s commitment to comply with all laws, regulations, company policies, and ethical requirements applicable to the conduct of the business. Assessing the need for additional training and education and developing appropriate compliance programs aligned with company growth and scale.

• Developing, coordinating, and overseeing internal and external audit procedures to monitor and detect misconduct or noncompliance. If any misconduct or noncompliance is detected, recommend a solution, and follow up to ensure the recommendations have been implemented.

• Formalizing and monitoring a system to enable employees to report any noncompliance without fear of retribution, ensuring that the reporting system is adequately publicized and that allegations of noncompliance are investigated and responded to promptly.

• In consultation with the Head of Operations, helping to ensure that there is a mechanism in place for disciplining instances of noncompliance (including the failure to prevent, detect, or report any noncompliance) appropriate to the nature and extent of the deviation, and ensuring consistency in the application of disciplinary action.

• Working with Human Resources to ensure a workforce with high ethical standards, including establishing minimum standards for conducting appropriate background and reference checks on potential employees.

• Continually improving the Compliance Program and implementing any necessary changes on an ongoing basis to enhance the prevention and detection of any noncompliance.

• In conjunction with the Primasun Legal team, interfacing with and, when appropriate, negotiating with external regulatory agencies.

• Leading accreditation efforts with various agencies, including interfacing with accreditation boards, managing internal preparation and action plans, and maintaining appropriate documentation for reviews and audits.

• Reporting to executive leadership at regular meetings, or as requested otherwise, on any significant compliance issues to ensure appropriate discussion of such compliance issues and that proper action is taken.

• Carrying out all duties and responsibilities as assigned by the Head of Operations.

Qualifications

Preferred Qualifications

• Demonstrated expertise and experience with healthcare-specific compliance and regulatory programs.

• Bachelor’s degree required.

• Law degree preferred with experience in health care law and specific knowledge of fraud and abuse, Sunshine Act, HIPAA, and HITRUST Act.

• Relevant healthcare compliance certification such as CHC preferred.

• Knowledge of Medicare/Medicaid reimbursement issues preferred.

• Auditing/CPA experience is a plus.

• Experience in reporting and remediating compliance issues preferred.

• Strong influencing skills and perseverance in investigating.

• Familiar with Telehealth and Federal and State regulations.

• Demonstrated experience successfully managing an organization through healthcare / digital health / telehealth accreditation processes (e.g. URAC, HiTrust, ISO27001) is preferred.

• Experience working in a start-up is preferred.

What it’s like to work at Primasun

We are a group of curious and passionate individuals who believe in making a difference in healthcare by leveraging data and technology. We want to work with people passionate about making a difference in healthcare and have strong perseverance to effect change in a world-class healthcare delivery system. We believe in the power of collaboration and teamwork. We are here to support each other, respect every individual's talent and unique contribution and treat all people fairly and equitably. We value diverse perspectives and pride ourselves on having an environment where differing opinions are shared.

Why Primasun 

Flexible work environment including remote option. 

Competitive salary & 401k retirement savings plan.

Equity opportunity for qualified positions.

Time off to help you recharge and connect with your family and loved ones.