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Casa Esperanza, Inc. (Boston) · 3 days ago

Associate Director of Compliance & Quality Improvement 000602 - G&A (salaried) Malden, MA

Malden, MA

Full-time

Hybrid

Lead/Staff, Director/Executive

$72K/yr - $75K/yr

4+ years exp

Casa Esperanza, Inc. is a bilingual/bicultural behavioral health treatment provider serving Boston and the Merrimack Valley. The Associate Director of Compliance & Quality Improvement is responsible for designing and managing a comprehensive compliance program to ensure adherence to regulations and internal policies while driving quality improvement across the organization.

Health CareNon ProfitRehabilitationResidential

Responsibilities

Compliance Program Leadership

Design, implement, and oversee the organization’s Compliance Department and comprehensive compliance program, ensuring alignment with regulatory requirements, accreditation standards, and organizational goals

Develop, update, and enforce compliance policies and procedures covering clinical, operational, billing, privacy, and administrative activities

Establish mechanisms for reporting, investigating, and resolving compliance concerns, ensuring timely and appropriate corrective actions and performance improvement projects

Create and maintain a compliance governance structure, that includes regular reporting to the leadership teams in conjunction with the Director of Clinical/Medical Operations & Network Strategy & Development which provides compliance forecasting on a continuous basis

Monitor regulatory developments in behavioral health and ensure timely communication and implementation of necessary changes

Regulatory Oversight & Risk Management • Oversee compliance with all applicable federal and state regulations, including HIPAA, CMS, Medicaid, Medicare, CARF, and other/payer-specific standards as needed

Develop a risk assessment framework to identify, prioritize, and mitigate potential areas of compliance vulnerability

Conduct and manage internal audits and monitoring activities to ensure accuracy and integrity in billing, documentation, clinical operations, and administrative practices

Lead investigations into compliance violations, coordinate corrective actions, and ensure follow-up and documentation

Serve as the organizational liaison for external audits, payer reviews, and regulatory inspections

Prepare comprehensive compliance reports and risk analyses for executive leadership

Program Management & Quality Initiatives • Establish and manage a structured Compliance Program Management Office (PMO) for overseeing ongoing and ad hoc compliance and quality improvement initiatives

Plan, lead, and track organization-wide projects focused on audit readiness, quality improvement, and risk reduction

Collaborate with Clinical and Operations leadership to align quality and compliance initiatives with performance improvement goals

Implement data-driven compliance dashboards and tracking systems for real-time visibility into key compliance indicators

Partner with the Quality and Clinical Operations teams to ensure performance improvement activities support regulatory compliance and best practices

Collaboration & Cross-Functional Engagement • With the collaboration of the Director, Clinical/Medical Operations & Network Strategy & Development work in close partnership with: • Payer Relations to ensure adherence to payer contract requirements, credentialing standards, and utilization review expectations. • Provider Relations to reinforce provider education, training, and compliance with documentation, coding, and clinical protocols. • Practice Management to maintain compliant workflows, patient privacy standards, and operational efficiency. • Human Resources to manage compliance training programs, employee onboarding education, and disciplinary processes when appropriate. • Finance & Billing Teams to ensure claims integrity and compliance with reimbursement requirements

Serve as a trusted compliance advisor to operational leaders, ensuring integration of compliance considerations in all decision-making processes

Training, Education & Culture • Develop and implement a comprehensive compliance training and education program for staff and leadership at all levels

Promote a proactive culture of compliance, ethics, and transparency throughout the organization

Provide ongoing guidance and mentorship to department leaders to strengthen internal accountability and compliance ownership

Qualification

Healthcare ComplianceBehavioral Health KnowledgeRisk ManagementCompliance Program LeadershipPayer ComplianceInternal AuditsRegulatory OversightProject ManagementAnalytical SkillsTraining DevelopmentCommunication SkillsCross-Departmental Collaboration

Required

Bachelor's and/or Master's degree in Healthcare Administration, or related field preferred but not required if equivalent experience standards are met

Minimum 4 - 5 years of experience in healthcare compliance, preferably within behavioral health, mental health, or integrated care systems

Demonstrated experience building and leading compliance programs or departments

Strong background in payer compliance, audits, and risk mitigation

Knowledge of federal and state healthcare regulations, including HIPAA, CMS, OIG, and behavioral health licensing standards

Proven ability to manage complex compliance initiatives and cross-departmental collaboration

Strong analytical, investigative, and project management skills

Exceptional written and verbal communication skills for training, policy development, and leadership reporting

Strategic thinker with the ability to operationalize compliance frameworks into scalable systems

Preferred

Certified in Healthcare Compliance (CHC) or Certified Professional Compliance Officer (CPCO) or willingness to obtain certification within one year of employment