Healthcare Compliance & Data Governance Manager

Equal Opportunity Employer/Disability/Veterans

Reliable Respiratory is a Durable Medical Equipment (DME) company that provides the highest quality level of service for patients in need of respiratory, diabetes, urology, and maternity support. Equipment provided includes, CPAPs, BiPAPs, AutoPAPs, nebulizers, oxygen equipment, ventilators, CGM devices, insulin pumps, and breast pumps.Each patient is treated with professionalism, understanding, and attentive service. We care about our customers, work closely with the medical community, and have highly skilled staff ready to assist customers in receiving the best care possible.

The Healthcare Compliance & Data Governance Manager will oversee company-wide compliance with federal and state healthcare regulations, including HIPAA, CMS, and payer-specific requirements. This individual will also implement and manage internal policies and procedures related to data security, patient privacy, and system governance. Working cross-functionally with operations, IT, sales, and leadership, this role will help future-proof our company as we scale. This is a hybrid position reporting to our Norwood, MA office several days per week 

Duties and Responsibilities

• Advise, direct, and educate employees in regulatory compliance.
• Create, implement, and maintain the effectiveness of a corporate compliance program.
• Support internal monitoring and auditing of the compliance program to measure effectiveness and address deficiencies.
• Educate the management team and staff about compliance, operational compliance issues, risk issues related to the agency's lines of business and appropriate details of the compliance program.
• Ability to investigate compliance concerns with confidentiality and safeguard employees who discover them.
• Maintain company compliance with applicable federal and state rules and regulations affecting the distribution of medical supplies and devices, specifically by: 
  • Obtaining and maintaining appropriate licensure, contracts and/or registration for offices
  • Coordinating Product Recalls and maintaining corporate policy/procedure
  • Monitoring and reporting on federal state rules and regulations that may affect company wholesale/retail distribution of medical supplies and devices.
• Provide oversight to ongoing monitoring and assessment of key quality indicators that are reported to the State, CMS, and The Joint Commission. 
• Maintains expert competence in accreditation (e.g. TJC, CARF, OIG, CAP as applicable) and regulatory standards.
• Leads continuous readiness efforts and coach others in the development of accreditation improvement capabilities.
• Maintain current knowledge of applicable federal and state laws, pending legislation reported in the federal register, revised accreditation standards, updated OIG (Office of Inspector General) work plans and monitor advancements in information privacy, security, and compliance technologies to determine the level and need for Agency adaptation.  
• Ensure that accounting staff and clinical providers understand the scope of practice directives for clinicians regarding which services can be claimed for reimbursement, and that such information is maintained and distributed appropriately.
• Serve as the primary corporate resource for Medicare/Medicare reimbursement information.
• Maintain and communicate knowledge of payer claim submission guidelines and coverage requirements.
• Develop and maintain positive rapport with payers, HCFA, and other applicable federal/state government agencies.
• Act as key negotiator in payer disputes.
• Other duties as assigned. 

Required Qualifications

• 18 years of age or older
• Must be eligible to work in the United States and not require work authorization from us now or in the future
• Bachelor’s degree in Healthcare Administration, Business, Compliance, or related field (required). Master’s degree or certifications (CHC, CHPC, CIPP, etc.) preferred.
• 4 years of experience in healthcare compliance or data governance, preferably in a DME, pharmacy, or healthcare provider setting.
• DME experience preferred 

Required Skills

• Familiarity with DMEPOS operations, patient data systems (e.g., Brightree, Kareo, Salesforce Health Cloud, or similar), and medical billing systems.
• Effective and professional verbal and written communication abilities
• Strong organizational and project management skills
• Ability to work independently to investigate and make decisions
• Ability to work in collaboration with others
• Ability to comply with guidelines both internal and industry-imposed
• Strong attention to detail 

  Competencies

• Analytical skills 
• Attention to detail
• Communication
• Decision making
• Dependability
• Ethics
• Job knowledge 
• Leadership

Work Environment & Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• While performing the duties of this job, the employee is regularly required to communicate and convey information with the appropriate parties. The job requires assuming a stationary position for long periods of time
• This role routinely uses standard office equipment such as computers, phones, and printers/scanners 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

• This job operates in a professional office environment
• The noise level in the work environment is usually moderate to loud if employee wished to be in office 

Direct Reports – TBD

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. 

Reliable Respiratory, INC participates in E-Verify. E-Verify is a web-based system that allows an employer to determine an employee's eligibility to work in the US using information reported on an employee's Form I-9. The E-Verify system confirms eligibility with both the Social Security Administration (SSA) and Department of Homeland Security (DHS). For more information, please go to the USCIS E-Verify website.