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Director, Compliance

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POST DATE 9/19/2017
END DATE 8/2/2018

Cotiviti USA, LLC Wilton, CT

Wilton, CT
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree



The Director, Compliance is the leadership position directly responsible for the strategic development, implementation, operation, and continuous improvement of the corporate compliance and business ethics program for Cotiviti, a leading and innovative analytics-driven payment accuracy company which provides services to the retail and healthcare industries. The company s compliance and ethics program is based on the 7 elements contained within the U.S. Federal Sentencing Guidelines as well as applicable federal and state health care compliance program standards.

This position is responsible for ensuring that the necessary policies and procedures, governance, training and education, risk identification and management processes and operational controls are implemented and operating effectively to ensure that the company s corporate compliance program is effectively preventing, detecting and responding to compliance and business ethics issues. The Director, Compliance, also provides expert guidance and analyses to the company s executive leadership team on issues relating to regulatory compliance and business ethics issues. This position will focus heavily on compliance with healthcare legal and regulatory issues applicable to the managed care industry, including those applicable to federal and state governmental programs (Medicare and Medicaid managed care), and also to government contractors. This position will report to the Vice President, Compliance and Risk, and will have direct line of sight to the Audit Committee of the Board of Directors.

Key Responsibilities:

Program Design

Develop, implement and continuously improve the corporate compliance and business ethics program, designed to promote a culture that fosters ethical and compliant behavior in accordance with applicable laws and regulatory requirements and which provides a basis for ensuring adequate internal controls are in place to prevent, detect and respond to non-compliance and ethical issues. Develop, initiate, maintain, and revise policies and procedures for the general operation of the compliance program and its related activities to prevent illegal, unethical, or improper conduct and to manage the day-to-day operations of the program. Develop and implement the necessary framework for collecting, analyzing, measuring, and reporting compliance metrics in order to measure and continuously improve the effectiveness of the program.

Program Execution

Collaborate with compliance and risk colleagues and other departments (e.g., Finance, IT, Human Resources, Operations) to direct compliance and ethics issues to appropriate existing channels for investigation and resolution. Conducts and/or oversees appropriate compliance investigations/inquiries. Operate an internal reporting process, including an anonymous telephone reporting system. Institute and maintain an effective compliance communication program for the organization, including promoting (a) use of the Compliance Hotline;(b) heightened awareness of Standards of Conduct, and (c) understanding of new and existing compliance issues and related policies and procedures. Develops and implements methods and programs that encourage employees at all levels and others to report concerns, suspected fraud, or other misconduct without fear of retaliation. Work with the Human Resources Department and others as appropriate to develop an effective compliance training program, including appropriate introductory training for new employees as well as ongoing training for all employees, managers and third parties as appropriate. Ensures appropriate screening is conducted to ensure the organization does not hire or conduct business with individuals or entities that have been excluded or debarred from participation in federal health care programs.

Compliance Activity Monitoring

Monitor, and as necessary, coordinate compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends. Identify potential areas of compliance vulnerability and risk, and develop/implement corrective action plans for resolution of problematic issues. Provide general guidance on how to avoid or deal with similar situations in the future. Monitor the performance of the compliance program and related activities on a continuing basis, taking appropriate steps to improve its effectiveness, including developing metrics for evaluating effectiveness of the program based on monitoring activities.


Chairs the internal quarterly Compliance Committee. Provide reports on a regular basis, and as directed or requested, to keep senior management and the Board of Directors informed of the operation and progress of the compliance program and any significant compliance issues. These Compliance Committee and Board reports include the development and ongoing enhancement of metrics related to the operation of the compliance program as well as compliance program effectiveness measures for governance and oversight purposes.


Skills And Experience:

* Minimum BS/BA in a related Field of Study, prefer JD, MBA/MHA or other appropriate advanced degree

* Health Care Compliance Association (HCCA) Certification in Healthcare Compliance (CHC or other similar compliance certification) (Preferred)

* Minimum Ten (10) years of experience developing, implementing and operating a corporate compliance and ethics programs within a healthcare-related organization.

* We are an Equal Opportunity Employer.

* Please view Equal Employment Opportunity Posters provided by OFCCP here.

* Cotiviti is an Equal Opportunity Employer. The Company provides equal employment opportunities to all applicants for employment without regard to gender, sexual orientation or preference, gender identity or expression, race, color, religion, national origin, ethnicity, ancestry, age, marital status, pregnancy, childbirth or related medical conditions, mental or physical disability, veteran status or any other characteristic protected by federal, state or local law, ordinance or regulation..

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment Opportunity Posters provided by OFCCP here.