Compliance Program Manager, Provider Operations - Jefferson Health Plan

Thomas Jefferson University • Philadelphia, PA

3d • 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 the development, implementation, and tracking of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position serves as a liaison between Compliance and Operations teams to maintain audit readiness and promote accountability and efficiency.

The role tracks compliance activities and deliverables, reviews department policies and procedures, conducts scheduled and targeted audits, and coordinates audit preparation and regulatory reviews. It also supports compliance training, risk mitigation, regulatory reporting, and standardized workflows. The position is based at 1101 Market in Philadelphia, Pennsylvania, and has a Workday Day shift.

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 audits or developing or 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.
• Ability to lift and carry 25 lbs.; frequent sitting, standing, and keyboard use.

Responsibilities

• Track and maintain compliance activities across all lines of business, including 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 according to departmental processes and workflows.
• Perform scheduled audits according to the Compliance Work Plan and ad-hoc targeted regulatory audits as needed.
• Oversee improvement action plans resulting from internal or external audits, including root cause analysis, progress tracking, education on audit errors, and timely completion of corrective measures.
• Lead audits and reviews by regulatory bodies, ensuring accurate data collection and timely submissions.
• Compile audit findings and report them to executive management and internal committees as needed.
• Prepare assigned teams for internal and external regulatory audits by reviewing prior audit materials and ensuring department readiness.
• Serve as the Compliance liaison for monthly Compliance team meetings.
• Research trends and identify potential compliance risks; develop improvement plans to address deficiencies.
• Assist in developing and delivering compliance training programs for staff.
• Standardize regulatory workflows to improve operational efficiency.
• 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 with 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 access for all colleagues, including per diem colleagues, adjunct faculty, and Jeff Temps

What This Job Offers

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