Privacy & Compliance Manager - Full-time - Day - Lawrenceville, NJ
About The Position
The Privacy & Compliance Manager serves as an expert in identifying, assessing, and investigating patient billing compliance and privacy risks. The role maintains current knowledge of rules, regulations, authoritative guidance, and standards related to Capital Health’s major billing and privacy compliance risks. It supports the Compliance Office’s independent appraisal function by conducting timely and accurate audits and investigations, including matters involving billing, coding, regulatory compliance, use and disclosure of Protected Health Information (PHI), policy compliance, and business risk. The role supports service lines across Capital Health, promotes communication and transparency across departments, advises management on legal and regulatory requirements, and manages the compliance self-monitoring program. It also serves as a resource to operational management on billing compliance and privacy regulations and policies, and as a primary investigator of privacy-related issues. The position collaborates with the Chief Compliance Officer and Director of Compliance to develop and carry out audit plans, assess compliance controls and training, conduct audits and investigations, prepare reports and recommendations, and provide compliance education. It also serves as a liaison to operational departments and the Capital Health LIFE program, including oversight of audits and reviews of CMS PACE program requirements. The position is full-time, scheduled for 40 hours per week, with an eight-hour usual workday, and is based in Lawrenceville, New Jersey.
Requirements
- Bachelor’s degree in healthcare, business administration, or a related field.
- Five years of related experience in a progressively responsible compliance or legal role.
- Expertise in federal, state, and other regulatory requirements.
- Intermediate computer skills.
- Critical-thinking ability and experience partnering with administrators and executives to develop and deliver initiatives and manage compliance matters.
Nice To Haves
- Master’s degree or JD in healthcare, business administration, or a related field.
- Compliance certificate.
- Knowledge and expertise in Program of All-inclusive Care for the Elderly (PACE) programs.
- Experience in a large hospital, multi-hospital system, or related setting.
Responsibilities
- Review and analyze policies, regulations, authoritative guidance, billing manuals, privacy guidance, procedural terminology descriptions, and other materials relevant to compliance risk.
- Recommend audit issues for the annual audit work plan and prepare draft audit work plans as directed by the Chief Compliance Officer.
- Develop audit protocols, tools, and work papers; identify and obtain necessary data and documentation; analyze materials; conduct interviews and on-site observations; and make follow-up requests as needed.
- Collaboratively implement the Compliance Department Work Plan, including identifying risk areas, assessing control systems, auditing, and assessing training.
- Meet with managers and directors to initiate compliance assessments; assess compliance control systems and training programs; prepare departmental scorecards; and provide implementation guidance and assigned compliance training.
- Prepare draft audit reports, review findings and corrective-action recommendations with the Chief Compliance Officer, participate in review meetings, and help manage the audit process to meet timelines and targets.
- Investigate potential noncompliance involving state and federal laws governing the use and disclosure of personally identifiable health information, including conducting interviews as directed.
- Serve as a point of expertise for privacy policy issues, guide operational management on implementing privacy policy and reducing privacy risk, conduct privacy reviews, and recommend improved controls.
- Serve as a point of contact for patient privacy complaints, interview patients, assess concerns, and recommend investigation plans to the Chief Compliance Officer or Director of Compliance.
- Make informed decisions, review and disposition incoming mail, faxes, and emails, respond to requests promptly, and protect the integrity and confidentiality of information.
- Analyze and track department participation and performance in the compliance self-monitoring program; collaborate with documentation and coding staff; and report results to the Chief Compliance Officer.
- Provide billing-compliance education and training as directed and identify information-system enhancements that promote compliance.
- Liaise with operational departments to educate directors, supervisors, and staff about monitoring protocols, tools, and plans; obtain information through data requests, analysis, document review, and interviews; and lead investigations as directed.
- Liaise with the Capital Health LIFE program, oversee and manage its audits, audit credentialing requirements, and review CMS PACE regulations for compliance.
- Maintain systematic, professional work papers and organized files that permit third-party review, following office electronic and paper filing systems.
- Perform other duties as assigned.
Benefits
- Medical plan
- Prescription drug coverage and in-house employee pharmacy
- Dental plan
- Vision plan
- Flexible Spending Account (healthcare and dependent care)
- Retirement savings and investment plan
- Basic and supplemental group term life and accidental death and dismemberment insurance
- Long-term and short-term disability benefits
- Employee Assistance Program
- Commuter transit and parking benefits
- Voluntary legal services
- Voluntary accident, critical illness, and hospital indemnity insurance
- Voluntary identity theft insurance
- Voluntary pet insurance
- Paid time-off program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
