Compliance Manager

JOB DESCRIPTION

Job Title: Compliance Manager

Date: July 2024

Status: Exempt

Department: Digital Health

Supervisor:

Number of Subordinates:

Pay Range: TBD

Job Summary:

This individual is responsible for ensuring organizational compliance with applicable laws, regulations, and standards related to Accountable Care Organizations (ACOs), Merit-based Incentive Payment Systems (MIPS), Medicare, Chronic Care Management (CCM), Skilled Nursing Facility (SNF) services, and Institutional Special Needs Plans (iSNP). This role involves monitoring, auditing, and implementing compliance programs, policies, and procedures to mitigate risks and enhance the organization's adherence to regulatory requirements.

Job Responsibilities:

• Conduct regular audits and reviews to ensure compliance with ACO, MIPS, Medicare, CCM, SNF, and iSNP regulations; develop and implement monitoring programs to detect compliance risks and areas for improvement; prepare detailed reports on audit findings and recommend corrective actions.
• Assist in the development, implementation, and maintenance of compliance policies and procedures; ensure that all policies and procedures align with current regulations and best practices
• Develop and deliver compliance training programs for staff to ensure understanding and adherence to relevant regulations and organizational policies; provide ongoing education and updates to staff on changes in regulations and compliance requirements
• Stay current with changes in ACO, MIPS, Medicare, CCM, SNF, and iSNP regulations and standards; ensure the organization is compliant with federal, state, and local regulations, including timely reporting and documentation
• Identify and assess compliance risks within the organization and develop strategies to mitigate these risks; work with various departments to implement risk mitigation strategies and monitor their effectiveness.
• Maintain accurate and up-to-date documentation of compliance activities, audit findings, and corrective actions; prepare and submit compliance reports to regulatory bodies as required.
• Collaborate with internal departments, including financial and operational teams, to ensure cohesive compliance efforts; serve as a point of contact for compliance-related inquiries and issues

Education Necessary for Position:

• Bachelor's degree in healthcare administration, Law, Business, or related field
• Master's degree or Juris Doctor (JD) preferred
• Certified in Healthcare Compliance (CHC) or similar certification preferred

Experience & Skills Necessary for Position:

• Minimum of 3-5 years of experience in healthcare compliance, preferably within ACO, MIPS, Medicare, CCM, SNF, or iSNP settings
• Experience conducting audits and implementing compliance programs
• Strong understanding of healthcare regulations and compliance requirements
• Excellent analytical, organizational, and problem-solving skills
• Effective communication and interpersonal skills
• Ability to manage multiple priorities and work under pressure
• Proficiency in Microsoft Office Suite and compliance software

Work Environment:

• Office environment with occasional travel to various facilities as required
• May require extended hours to meet regulatory deadlines or during audits.

Organizational Relationships:

• Develop and maintain positive internal and external organizational relationships that would contribute to the success and growth of the company.