Compliance Program Manager, Provider Operations - Jefferson Health Plan

Jefferson Health Plans • Philadelphia, PA

4d • Onsite

About The Position

The Compliance Program Manager oversees compliance activities across Medicare, Medicaid, CHIP, and ACA lines of business. The role ensures policies and procedures align with regulatory requirements, manages internal and external audits, and leads corrective action planning. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. The position serves as a liaison between Compliance and Operations teams to maintain audit readiness and promote accountability and efficiency.

The role tracks compliance activities, reviews policies and procedures, conducts scheduled and targeted audits, and oversees improvement action plans, including root cause analysis and progress tracking. It provides leadership during regulatory audits and reviews, prepares teams for audits, supports monthly Compliance team meetings, researches potential risks, develops compliance training, standardizes regulatory workflows, and supports regulatory reporting and performance initiatives.

Requirements

• Bachelor’s degree in a relevant field such as Business Administration, Healthcare Administration, Public Health, Compliance, Risk Management, or a related field.
• Five years of experience in compliance, auditing, or risk management; healthcare operations or a highly regulated industry; and managing or coordinating internal/external audits or developing/overseeing compliance monitoring activities.
• Strong analytical and critical-thinking skills to assess compliance risks and identify solutions.
• Excellent written and verbal communication skills for reporting, training, and collaboration.
• Project and program management skills to organize, prioritize, and track multiple compliance initiatives.
• Audit and monitoring skills, including data collection, analysis, and reporting.
• Ability to develop, conduct, and deliver effective compliance training programs.
• Conflict resolution and negotiation skills.
• Attention to detail and accuracy in documentation and reporting.
• Strong interpersonal skills and ability to build relationships across departments and with external regulators.
• Ability to interpret and apply complex regulations and policies to business operations.
• Ability to work independently and as part of a team in a fast-paced environment.
• Ability to lead cross-functional teams and manage multiple stakeholders.
• Skill in identifying compliance gaps and driving corrective action.
• Adaptability to changing regulatory environments and business needs.
• Strong organizational and time-management skills.
• Ability to maintain confidentiality and handle sensitive information ethically.
• Facilitation and presentation skills to engage and educate staff.

Responsibilities

• Track and maintain compliance activities across all lines of business, coordinating with department units on inquiries, audit deliverables, and regulatory reporting.
• Review department policies, procedures, and desktop procedures for alignment with regulatory requirements.
• Conduct monitoring across Medicare, Medicaid, CHIP, and ACA lines of business according to departmental processes and workflows.
• Perform scheduled audits under the Compliance Work Plan and ad-hoc targeted regulatory audits as needed.
• Oversee development, implementation, and management of improvement action plans arising from internal or external audits, including root cause analysis, progress tracking, education on audit errors, and timely corrective measures.
• Lead audits and reviews by regulatory bodies, ensuring accurate data collection and timely submissions; compile findings and report them to executive management and internal committees as needed.
• Prepare assigned teams for regulatory audits by reviewing previous audit materials and results and ensuring readiness for active and upcoming audits.
• Serve as the Compliance liaison for monthly Compliance team meetings.
• Research trends and identify potential compliance risks; develop internal improvement action plans to address deficiencies.
• Assist in developing, producing, and conducting compliance training programs for staff.
• Improve operational efficiency by standardizing regulatory workflows.
• Support and deliver regulatory reporting and performance initiatives.

Benefits

• Medical insurance, including prescription coverage
• Supplemental insurance
• Dental insurance
• Vision insurance
• Life and AD&D insurance
• Short- and long-term disability insurance
• Flexible spending accounts
• Retirement plans
• Tuition assistance
• Voluntary benefits, including access to group insurance rates and discounts
• Tuition discounts at Thomas Jefferson University after one year of full-time service or two years of part-time service
• Medical insurance, including prescription coverage, for colleagues including those who work less than part-time

What This Job Offers

• Job Type: Full-time
• Career Level: Manager