Clinical Compliance Manager

Texas Health Action•Austin, TX

About The Position

Texas Health Action (THA) is a community-informed non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment, with expertise in serving LGBTQIA+ people and those impacted by HIV. Kind Clinic proudly serves Texas with four vibrant locations: two in Austin, one in San Antonio, and another in Dallas plus virtual care services available to all residents across Texas. Bolstered by Waterloo Counseling Center and a passionate team of over 250 dedicated employees and volunteers, THA is at the forefront of promoting healthcare equity and accessibility throughout the state. Read more about THA here: http://texashealthaction.org. The Clinical Compliance Manager provides advanced leadership in clinical compliance, clinical risk mitigation, documentation integrity, and regulatory preparedness. The role ensures that all clinical operations adhere to federal and state regulations, payer requirements, accreditation standards (e.g., URAC, Joint Commission, PCMH), infection prevention protocols, and internal quality expectations.

Requirements

Bachelor’s degree in nursing, health information management, healthcare administration, or a related field required; clinical licensure (RN, PA, NP, LVN, RT, etc.) is strongly preferred.
3–5 years of experience in clinical compliance, quality management, HIM/coding, infection control, or clinical operations.
Strong working knowledge of clinical documentation standards, coding regulations, accreditation requirements, and payer medical necessity guidelines.
Experience with EHR systems, audit tools, incident reporting systems, and clinical quality analytics.
Must have basic PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word, and Excel.
Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards.
Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse people groups.
Well-developed verbal and written communication skills in English; Additional language abilities desirable.
Ability to work well under pressure with minimal supervision.
Ability to effectively interact with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes, those in crises or resistant or negative toward organizations.
Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines.
Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities.
Must be able to work productively with other departments and employees.
Ability to work with professionals from various partners and organizations.
Usually works forty (40) hours per week, some weekends may be required.
Ability to successfully manage conflict, negotiating “win-win” solutions.
Must be able to multi-task, prioritize with strong time management skills.
Exceptional follow-through on tasks and assignments
Must possess leadership qualities and be able to supervise and secure the cooperation of staff
Perform the following with or without reasonable accommodations: Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips.
Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly.
Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound.
Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects.
Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze.
Must be able to work and concentrate amidst distractions such as noise, conversation, and foot traffic; ability to handle interruptions often and be able to move from one task to another.
While worker may possibly be subjected to temperature changes, the worker is generally not substantially exposed to adverse environmental conditions as the work is predominantly inside.

Nice To Haves

Certification preferred: CIC, CPHQ, CCS, RHIA/RHIT, CHC, or other clinical/quality/compliance credentials.
Prior experience working with LGBTQIA+ and/or other marginalized communities strongly preferred.
Additional language abilities desirable.

Responsibilities

Lead clinical documentation, coding, and medical necessity audits (E/M, telehealth, specialty services, risk adjustment) and deliver actionable findings, provider education, and trend analysis
Provide compliance oversight of provider competency, onboarding, credentialing, and privileging processes in alignment with regulatory and accreditation requirements
Support clinical governance through participation in peer review, performance reviews, quality councils, and multidisciplinary committees
Oversee infection prevention and clinical safety compliance, including immunization protocols, exposure control, incident reporting, and environmental rounds
Identify clinical safety risks, conduct incident reviews and root-cause analyses, and track remediation to completion
Drive regulatory readiness for accreditation surveys, payer audits, and inspections through gap analysis and compliance assessments
Provide governance and oversight for peer review and utilization review programs to ensure appropriateness of care and adherence to payer and evidence-based standards
Lead development, review, and implementation of clinical policies, procedures, and practice guidelines aligned with evidence-based standards
Develop and deliver system-wide education on clinical compliance, documentation accuracy, emerging regulations, and quality standards
Monitor, analyze, and report clinical compliance metrics, audit results, and risk trends to clinical and executive leadership
Partner closely with Continuous Quality Improvement (CQI), Risk, and Corporate Compliance teams to translate regulatory findings into sustainable quality improvement initiatives