Compliance Manager, Payer Services

Integra Partners•Troy, MI

4d•$120,000 - $120,001•Remote

About The Position

The Legal team at Integra Partners, a Dragonfly Health company, works cross-functionally to help achieve our mission of reducing friction in healthcare. We are committed to working collaboratively, transparently, and efficiently to provide exceptional legal and compliance services to our internal stakeholders, health plans, and providers. We are committed to excellence in our work, a growth mindset and continuous improvement, and cultivating a deep understanding of the healthcare industry. We are hiring a Compliance Manager to be an integral member of the Legal team and ensure we meet and exceed all our compliance obligations. In this role, you will bring your previous compliance experience and knowledge to drive compliance strategy and identify risks. Some of your key responsibilities will be administering our compliance program and assisting with the integration of general compliance processes, overseeing Managed Care audits and managing the compliance relationships with our customers as well as keeping up-to- date and managing compliance changes that impact our business and the DMEPOS industry. You will work closely with our General Counsel, Payer Services and partner with individuals at all levels of the company. This role will manage a compliance analyst, who will conduct FWA investigations of our network and risk reviews. You will also support the privacy program. If you are a self-starter, service-oriented, and able to interpret and communicate complex information, then this is an excellent opportunity as a next step in your career.

Requirements

At least six years’ experience in corporate compliance or similar roles; previous healthcare experience is preferred.
Strong understanding of revenue cycle management, fraud waste and abuse issues, healthcare credentialing, CMS guidelines, medical billing, HIPAA, HITECH, and related legislation
Strong analytics background, particularly claims data analysis
Strong attention to detail
Excellent written and verbal communication skills
Demonstrate strategic thinking to implement continuous improvement efforts for our compliance program
Experience drafting and reviewing policies and procedures
Excellent organizational skills, ability to manage multiple projects at once, follow through, and meet tight deadlines.
A commitment to provide high quality client service and a strong desire to build trusted advisor relationships with key clients and executives.
Ability to manage and handle sensitive and confidential information with the highest levels of integrity, ethical standards, discretion, and sound judgment.
Team player able to collaborate across various teams and levels and form strong working relationships.
Ability to deliver results in a fast moving, and fast changing, environment.

Nice To Haves

JD preferred.

Responsibilities

Administer the company’s Corporate Compliance program, including creating and documenting initiatives through managing regular meetings with teams, ensuring projects are on task and goals are met, and reporting on progress to leadership
Develop, assign and monitor compliance training and keep detailed, auditable records
Own Fraud, Waste, and Abuse investigation processes, reporting out to senior leaders and customers
Lead calls with Payers and DME providers on issues of interest
Research and advise on compliance issues that impact our business
Collaborate with our credentialing, quality assurance, and network management teams to address any concerns and implement change as needed
Manage the compliance training program
Develop compliance programs and initiatives for employees
Conduct audits of vendors and healthcare providers
Partner with health plans on audits of our business
Investigate compliance concerns and issues internally and externally
Ensure we are up to date with licensing and other filings with state agencies
Audit current legal, compliance, and related policies, to comply with current contractual, legal, and regulatory obligations; implement change as needed.
Conduct Security Risk Assessments and present results to the compliance committee.
Work closely with our data security staff to address security issues that arise
Manage license renewals