Compliance Program Manager

Pediatrics Plus Website•Conway, AR

4d•Onsite

About The Position

We are currently seeking a Compliance Program Manager to join our team of highly qualified professionals that share our mission of Empowering Children to Conquer their World! The Compliance Program Lead will be instrumental in planning, implementing, maintaining, and administering a system-wide compliance program for Pediatrics Plus, ensuring adherence to healthcare regulations, including HIPAA, billing codes, and internal policies. They will proactively monitor potential compliance risks, develop and implement preventative measures, and foster a culture of compliance to protect the practice, its clients, and stakeholders. The Compliance Program Lead will empower teams to prioritize compliance as a business enabler, promote ethical behavior at all levels, and ensure seamless integration of compliance practices into day-to-day operations. The Compliance Program Lead will also provide strategic guidance to ensure compliance practices align with the growth goals of Pediatrics Plus while mitigating risk.

Requirements

In-depth knowledge of HIPAA regulations, healthcare billing practices, and federal/state healthcare laws.
Experience conducting audits, risk assessments, and investigations.
Proven ability to communicate compliance concepts to both clinical and administrative team members.
Strong business acumen and strategic thinking skills, with the ability to translate vision into actionable plans and initiatives.
Strategic problem-solving and decision-making abilities, with a focus on driving results and continuous improvement.
Strong organizational and leadership skills.
Exceptional attention to detail and analytical skills.
Excellent interpersonal, verbal, and written communication
Ability to manage multiple priorities and meet deadlines.
High level of integrity and commitment to confidentiality.
Bachelor's degree, required.
3+ years of experience in healthcare compliance or a related field; experience in pediatrics or clinical healthcare, preferred.

Nice To Haves

Certification in healthcare compliance (CHC) or similar credential, preferred.
If the team member is working at a Farm location, they must be comfortable around standard farm animals, including minimal allergies to touching, smelling, feeding, and engaging with animals.

Responsibilities

Ensures adherence to all healthcare regulations, including HIPAA, HITECH Act, OSHA, Stark Law, and federal/state requirements for pediatric practices.
Under the guidance and direction of the Chief Legal Officer and Compliance Committee, the Compliance Program Lead will develop and implement strategies to ensure ongoing compliance with evolving healthcare laws and regulations.
Coordinates internal and external compliance audits and inspections and as designated by the Chief Legal Officer, serves as a point of contact with regulatory agencies.
Under the direction of the Chief Legal Officer and Compliance Committee, develops, maintains, monitors, and continuously improves a comprehensive compliance framework, including policies, procedures, and standards aligned with healthcare regulations and best practices.
Establishes governance structures to ensure compliance initiatives are effectively monitored and reported.
Conducts regular evaluations of compliance programs to identify areas for improvement.
Assists the Chief Legal Officer in developing the annual Compliance Work Plan and is responsible for coordinating and tracking implementation of approved work plan activities.
Develops policies to safeguard Protected Health Information (PHI) and ensure full compliance with HIPAA and other privacy regulations.
Leads investigations into data breaches or privacy violations and implements corrective actions.
Conducts regular team member training on privacy practices, data security, and the importance of protecting patient information.
Monitors and reviews billing processes to ensure accurate coding and compliance with payer requirements.
Conducts internal compliance audits to detect errors, prevent fraud, and improve the accuracy of claims submissions or other regulatory requirements.
Collaborates with the operations, billing, and finance teams to implement corrective actions for discrepancies.
Identifies, assesses, and proactively mitigates compliance risks across Pediatrics Plus.
Reports and investigates compliance concerns, including anonymous reporting channels.
Conducts and documents investigations into compliance incidents and, as appropriate, recommends corrective and preventive measures to mitigate risk of recurrence.
Develops and delivers ongoing education and training programs for clinical and administrative team members on compliance topics, including regulatory changes, HIPAA, billing, and ethical behavior.
Fosters a culture of integrity, accountability, and transparency within Pediatrics Plus.
Ensures all team members understand their responsibilities regarding compliance and the ethical standards of Pediatrics Plus.
Designs and implements routine and targeted audits to monitor compliance with internal policies and external regulations.
Prepares reports on audit findings and presents recommendations for corrective actions.
Develops metrics to track the effectiveness of compliance initiatives and regularly reports results to senior leadership and stakeholders.
Stays abreast of industry trends and emerging risks, incorporating them into proactive compliance strategies.
Leads efforts to continuously improve compliance processes, leveraging technology and best practices for greater efficiency.
Participates in one-on-one meetings with leader.
May perform other related and non-related duties, as assigned.