Compliance Manager Jobs

About The Position

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field.
• Minimum of 5-7 years of experience in healthcare compliance, with significant experience in auditing, coding, and physician practice/ambulatory care settings.
• In-depth knowledge of federal and state healthcare regulations, including Stark Law, Anti-Kickback Statute, and HIPAA.
• Proficiency with ICD-10 and CPT-4 coding methodologies, physician documentation, and reimbursement principles.
• Demonstrated experience in developing and implementing compliance programs, conducting audits, and leading investigations.
• Proficiency in the use of electronic health records (EHRs), preferably Epic Ambulatory.
• Strong analytical, problem-solving, and project management skills.
• Excellent interpersonal, presentation, and written communication skills.
• High degree of professionalism, integrity, and ability to work collaboratively with physicians, staff, and leadership.
• Proficient computer skills that include but are not limited to Google Suite and/or Microsoft Office platforms.

Nice To Haves

• Familiarity with The Joint Commission (TJC), state Department of Health, and CMS regulations.
• Proficiency in Epic Ambulatory.
• Certification in Healthcare Compliance (CHC).
• A coding credential (e.g., CPC, CCS).

Responsibilities

• Performs and oversees retrospective and concurrent audits and performance improvement reviews to ensure compliance with regulatory and payer requirements.
• In partnership with the Deputy Chief Compliance Officer, manages staff auditors.
• Reviews physician and advanced practice provider documentation in the medical record for appropriateness and to ensure that billing is reflective of the services provided.
• Reviews medical records to assess appropriate ICD-10 and CPT-4 assignment for Medicare, Medicaid, and commercial payers for reimbursement purposes.
• Develops, implements, and maintains an effective compliance program, including policies, procedures, and a compliance manual for physician practices and ambulatory care.
• Maintains current knowledge of payer and regulatory requirements, including federal and state laws such as the Stark Law and Anti-Kickback Statute.
• Develops content and conducts ongoing compliance training and education for physicians, management, and staff on relevant laws, regulations, and identified risk areas.
• Facilitates the timely submission of accurate claims through daily interaction with practice leadership, physicians, coders, and the Physician Billing Department.
• Monitors all aspects of the revenue cycle to ensure compliant reimbursement and provides reports to leadership as needed.
• Manages and conducts investigations into compliance-related concerns, ensuring timely and thorough resolution.
• Serves as an active participant in workflow development within the practice and the Electronic Health Record to ensure compliant documentation and billing.
• Acts as a liaison to the Physician Billing Department and any external coding or billing services, maintaining open lines of communication.
• Prepares and presents regular reports to the Deputy Chief Compliance Officer and Compliance Committee on program status, audit findings, and investigative matters.
• Other duties and/or projects as assigned.
• Adheres to HMH Organizational competencies and standards of behavior.

Benefits

• health
• dental
• vision
• paid leave
• tuition reimbursement
• retirement benefits