Compliance Manager

Minimum Education
Bachelor's Degree (Required)
Master's Degree in health law, health administration or business administration (Preferred)

Minimum Work Experience
5 years experience in healthcare compliance, healthcare operations or related (Required)

Required Skills/Knowledge
Knowledge of federal healthcare program laws and regulations

Required Licenses and Certifications
Certified Healthcare Compliance 1 Year (Required)

Functional Accountabilities
Healthcare Compliance

• Maintain a working knowledge of relevant laws, rules, and regulations governing the healthcare services and clinical practice.

• Stay current on relevant industry and government compliance program guidance, investigations, and audit; stay abreast of and provide updates regarding changes in legislation, regulations and other requirements that may result in organizational response.

• Provide management of compliance, quality and standards projects within various business operations.

• Develop initial interpretation of relevant regulations and guidelines and act as a regulatory subject matter expert (SME)for business operations including responding to questions and concerns.

• Develop expertise and perform research in compliance and issues as requested.

• Support the development and management of the various compliance programs, such as policy and education, pharmacy, conflict of interest, research, and physician compliance program.

• Assist business with inspections, regulatory responses and consult on root cause analysis, as required.

• Conduct and perform compliance related activities, including audits, risk assessments, and other identified compliance activities, in support of the Compliance Workplan.

• Coordinate implementation of overall Compliance Workplan and Code of Conduct; consult and provide guidance on a regular basis on related issues with operations directors/managers to ensure conformance with applicable laws and regulations.

• Develop materials in support of the Compliance Management Committee and related work groups.

• Assist in periodic reviews and revisions of the Compliance policies and procedures.

• Assist the Compliance Officer with other department activities, as assigned.

Internal Investigations & Reviews

• Conduct and document investigations in accordance with applicable legal requirements and organizational policies and procedures.

• Upon completion of investigation, ensure completion of corrective actions plans.

• Conduct assessments, document results, and oversee mitigation efforts implemented to reduce or eliminate risk/issues.

Compliance Education & Training

• Support the compliance training programs on a day-to-day basis, ensuring timely completion of on-boarding and topic specific training and education by the workforce.

• Prepare and develop education materials.

• Provide compliance educational and training as needed.

• In partnership with the Legal Department, serve as a subject matter resource and provide consultation services regarding the application and implementation of current legal requirements and organizational policies and procedures.

Auditing & Monitoring

• Identification of healthcare focus areas by the OIG and other regulatory bodies to assist in forming the compliance audit and monitoring work plan.

• Development and implementation of risk assessments and audits; capture and monitor corrective action plans until resolution.

• Perform auditing and monitoring to ensure compliance with all federal, state & local regulations, as well as fiduciary requirements, and identify areas of vulnerability and risk.