Healthcare Compliance Investigations Manager

Role Overview

Summary/Objective: Leads and oversees NorthStar’s compliance investigation’s function, ensuring investigations are objective, timely, consistent, and well-documented, in accordance with state and federal laws, regulations, payer expectations, and organizational policies. Strong contributor to a best-in-class compliance and privacy program.

*This position can be performed from anywhere within the United States. Candidates must have reliable internet access and be able to work effectively in a virtual environment.  Work site attendance may be required from time to time in accordance with business conditions.

Essential Functions: 

• Responsible for the compliance investigation’s function, including case intake of inquiries and allegations, triage, prioritization, investigation planning, documentation standards and review, resolution, report writing, follow-up and closure.
• Conducts interviews, gathers and reviews relevant documentation, prepares investigative reports, action plans, and follow up.
• Support compliance program staff by providing consultation on investigative strategy and execute consistent investigation practices.
• Responsible for the preservation and investigation recordkeeping activities are performed including appropriate documentation, investigative records, analysis, and close out of all investigations in shared files and case management system.
• Evaluate and escalate allegations involving healthcare laws, regulations, payer requirements, organizational policies, privacy and security obligations, billing practices, fraud, waste and abuse, and standards of ethical conduct.
• Conduct annual compliance program awareness survey and report results as well as implement any corrective actions identified in data analysis.
• Responsible for partnering with relevant departments to ensure investigations are appropriately coordinated, resolved, and tracked.
• Recommend policy updates, education, monitoring, repayment review, disciplinary referral, or process improvements.
• Maintain and monitor investigation metrics, timelines, outcomes, and corrective action plans to support leadership reporting and oversight.
• Synthesize complex information, perform root cause analysis, identify compliance issues and trends, translate findings into practical risk mitigation strategies that may include auditing recommendations, monitoring, education, and/or practical risk mitigation priorities.
• Support compliance program governance by preparing investigation summaries, trend reports, and recommendations for senior leadership, compliance committees, and other oversight forums.
• Maintain current knowledge of applicable healthcare compliance requirements, including HIPAA, fraud, waste and abuse standards, federal and state healthcare program rules, and internal policies.

Qualifications:

• Bachelor’s degree in Business, Healthcare Administration, or related field of study.
• Experience in conducting investigations in a hospital, health system, physician group, or other regulated healthcare environment required, as well as competency in Healthcare Compliance required.
• 2 years of supervisory, team lead, project lead, or case management experience, preferably in a healthcare compliance or investigations environment
• Professional certification in either healthcare compliance or investigations is required.
• Use compliance case management systems, audit tools, electronic health records, claims data, reporting dashboards, and data analytics.
• Knowledge of compliance risk assessment, corrective action planning, monitoring, reporting, and governance practices.

Knowledge, Skills and Abilities:

• Strong judgment and objectivity when assessing sensitive matters.
• Excellent interviewing, listening, and fact-gathering skills.
• Strong written communication skills with the ability to produce clear, organized reports.
• High attention to detail and ability to manage complex information with discretion and professionalism.
• Expertise in Microsoft Office applications, including Excel, Word, and PowerPoint.
• Current knowledge of applicable federal and state healthcare regulations.
• Knowledge of compliance program requirements and procedures.
• Strong critical thinking and analytical skills.
• Excellent verbal, written, and presentation skills.
• Strong organizational and planning skills with the ability to manage competing priorities.
• Ability to maintain strict standards of confidentiality and ethical conduct.
• Demonstrate analytical rigor, create reports, dashboards, graphs and charts as required

Competencies:

• Oral and Written Communication with internal and external clients
• Problem Solving/Analysis
• Initiative
• Thoroughness
• Teamwork Orientation
• Time Management
• Follow-up
• Technical/Professional Knowledge and Skills
• Work Standards

About NorthStar

NorthStar Anesthesia is a company of caregivers, founded by an anesthesiologist and a Certified Registered Nurse Anesthetist (CRNA). With more than 4,000 anesthesiologists and CRNAs under its banner, NorthStar partners with more than 280 client sites across over 20 states and counting to deliver a more productive and efficient model of anesthesia care. Its "care team" approach focuses on the provision of high-quality care while measurably improving operating room performance.

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