VP, Compliance

This is a fully remote position, open to applicants in United States.

📋 Description

• Develop, implement, and enhance a comprehensive enterprise compliance program that encompasses all aspects of Abby Care's healthcare operations, aligned with the OIG seven-element framework and the DOJ's guidance on Corporate Compliance Programs.

• Define the company's compliance strategy and objectives, including the annual enterprise risk assessment, multi-year work plan, audit and monitoring schedule, and yearly program effectiveness evaluation; ensure resource allocation and Board approval for execution.

• Create and manage the complete operational framework of the program — including policies and procedures, training and culture, reporting and hotline channels, monitoring and auditing, investigations, discipline, and corrective actions — ensuring each component operates effectively, is measurable, and continually improves.

• Oversee compliance throughout the entire program lifecycle, covering clinical operations, documentation, billing and coding, EVV, payor and MCO contract performance, and program integrity; strive to cultivate a culture of compliance by integrating it into the business operations rather than treating it as an add-on.

• Manage regulatory change across federal regulations (AKS, Stark, FCA, HIPAA/HITECH, CMS, OIG, HRSA, and the 21st Century Cures Act) and within the various state Medicaid environments where we operate.

• Handle all government inquiries, audits, investigations, self-disclosures, and any settlement or CIA obligations; act as the company's main compliance point of contact for regulators, MCO program integrity teams, and external legal counsel.

• Collaborate with Legal, Human Resources, Operations, Clinical Leadership, Information Security, and Finance to incorporate compliance controls throughout the workforce, software and vendor ecosystem, and care delivery model.

• Work alongside the General Counsel on compliance initiatives related to AI governance and the application of AI in clinical and operational workflows, including FDA SaMD/CDS analysis, documentation integrity, and patient-facing disclosures.

• Drive compliance diligence and integration for new market entries, new Medicaid program designs, new service lines, and mergers and acquisitions activities.

• Act as the designated Compliance Officer for the company; chair the Compliance Committee; provide regular reports to the Board on risk posture, incidents, and program effectiveness, with independent access as required.

• Recruit, train, and lead a high-performing in-house compliance team, specializing in investigations, auditing and monitoring, training, compliance operations and analytics, and the technological infrastructure that supports a modern compliance program.

⛳️ Requirements

• Over 10 years of progressively responsible compliance experience in a healthcare setting, including a minimum of 5 years in a Director role or higher.

• Proven history of designing, building, or significantly rebuilding and scaling an enterprise compliance program, rather than merely managing an existing one.

• Demonstrated comprehensive ownership of all seven OIG compliance program elements, rather than partial responsibility for just one or two components.

• Significant experience in organizations funded by government healthcare programs (Medicaid, Medicaid waivers, Medicare, and managed Medicaid).

• Strong understanding of the federal healthcare regulatory framework (AKS, Stark, FCA, HIPAA/HITECH, CMS, and OIG guidance) as well as state Medicaid program integrity requirements.

• Experience operating across multiple states and the ability to manage a thorough, systems-based program across several state Medicaid environments simultaneously.

• Excellent judgment on risk trade-offs, strong written communication skills, and the ability to assert and defend a position with executives, the Board, and regulators.

• Ability to thrive in a fast-paced, growth-oriented environment with imperfect data, competing priorities, and the necessity to draft policies independently before implementation.

🏝️ Benefits

• Health insurance

• Remote work options

• Professional development opportunities