Compliance Director

Job Description

Job Description

The Compliance Director provides leadership in aligning organizational practices with requirements established by the Ohio Department of Mental Health and Addiction Services (OhioMHAS), Ohio Department of Medicaid (ODM), and the Centers for Medicare & Medicaid Services (CMS), as well as privacy and security standards outlined in the Health Insurance Portability and Accountability Act (HIPAA). The position ensures that all services meet licensure, certification, and reimbursement requirements while promoting ethical and compliant clinical and administrative operations.

This role oversees the development and enforcement of compliance policies, procedures, and internal controls designed to prevent, detect, and correct regulatory violations. The Compliance Director leads routine audits, risk assessments, and monitoring activities related to clinical documentation, billing practices, patient rights, and service delivery. Findings are analyzed to identify trends and areas of risk, with corrective action plans implemented and tracked to resolution.

Reporting to the Chief Operations Office, this position works closely with clinical teams and medical staff to ensure care delivery meets state and federal regulations while maintaining patient safety and ethical standards. They also collaborate with billing, human resources, and executive leadership to align documentation, workforce practices, and organizational policies with requirements from Medicaid, licensing bodies, and accreditation agencies.

ESSENTIAL RESPONSIBILITIES

• Develop, implement, and oversee the organization's compliance program in accordance with federal and state regulations, including the Ohio Department of Mental Health and Addiction Services, Ohio Department of Medicaid, Joint Commission, and the Centers for Medicare & Medicaid Services
• Ensure compliance with privacy and security standards under the Health Insurance Portability and Accountability Act
• Adherence to all Joint Commission and OHMAS safety requirements
• Conduct routine internal audits, risk assessments, and compliance monitoring of clinical, operational, and billing practices
• Identify compliance risks and implement corrective action plans to address deficiencies and prevent recurrence
• Establish a safety committee and a tracking mechanism for client right grievances
• Oversee incident reporting systems, including investigation and resolution of compliance concerns and critical incidents
• Develop and execute safety committee meetings
• Implement a clients rights officer for client grievances
• Conduct internal documentation audits to review: diagnosis, appropriateness of care, and justified treatment
• Ensure all compliance related initiatives are in place for all new programming
• Serve as the primary liaison for external audits, surveys, and regulatory reviews, including accreditation bodies such as the The Joint Commission
• Develop, update, and enforce policies, procedures, and SOP's to ensure regulatory adherence and operational integrity
• Organize and schedule compliance training and education to staff on regulatory requirements, documentation standards, and ethical practices
• Monitor changes in laws and regulations and ensure timely integration into organizational policies and workflows
• Collaborate with executive leadership and clinical teams to promote a culture of compliance and continuous quality improvement
• Payer requirements- knowledge of Ohio Medicaid and Commercial insurance audit protocols
• Ensure all Joint Commission requirements (past audit) are being completed and maintained.
• Track all agency incident reports
• Ensures all compliance related checklists (environmental safety, client safety, clinical data gathering, trainings, safety committee meeting minutes) are completed in a timely manner.

EXPERIENCE/QUALIFICATIONS/CREDENTIALS

Minimum Qualifications

• Degree in healthcare administration, public health, behavioral health, or a related field
• Understanding clinical standards of care
• Experience in risk management and liability: understanding diagnosis and ability to assess suicide risk
• Licensed in the State of Ohio (LSW/LPC)
• Minimum 5 years of experience in healthcare compliance, clinical operations in a behavioral health or substance use disorder (SUD) services
• Demonstrated knowledge of federal and state regulations, including requirements from the Ohio Department of Mental Health and Addiction Services, Ohio Department of Medicaid, and the Centers for Medicare & Medicaid Services
• Strong understanding of the Health Insurance Portability and Accountability Act and other applicable privacy and fraud, waste, and abuse laws
• Experience conducting audits, risk assessments, and developing corrective action plans
• Knowledge of Joint Commission accreditation standards
• Proven leadership experience, including supervision of staff and cross-functional collaboration
• Strong analytical, problem-solving, and organizational skills
• Excellent written and verbal communication skills