Healthcare Compliance Manager

Position Summary
The Compliance Manager reports to the Director and is responsible for assisting with the facilitation, implementation, oversight, and ongoing operation of the Compliance section.

Essential Functions of the Job:

• Administer and lead the Compliance Program in collaboration with the Director and Management team.

• Implement systems and processes designed to ensure compliance with applicable laws, regulations, and standards (e.g., Department of Health and Human Services, including the Centers for Medicare and Medicaid Services (CMS) and the Office of the Inspector General (OIG)).

• Monthly monitoring/review of the OIG exclusion list to ensure that all contracted providers are in good standing.

• Provide compliance monitoring, reporting, and training in collaboration with the Management Team.

• Monitor and ensure that all compliance requirements are met in regard to the California Child and Adult Care Food Program.

• Ensure contract compliance and conduct regular and ongoing contract reviews and site visits as required. Prepare site visit reports and ensure appropriate follow-through on any areas of improvement.

• Responsible for periodic chart reviews ensuring compliance with documentation in accordance with internal policies.

• Responsible for monitoring all HPMS memos as well as any other CMS correspondence and distributing them to appropriate staff.

• Review, monitor, and ensure compliance involving pharmacy and 340B requirements, including review of related reports and communication through assigned web portals.

• Knowledge of other disciplines outside of own area of expertise, including business planning, HIPAA privacy, clinical disciplines, human resources, finance, clinical and financial auditing, and information technology is desired.

• Working knowledge of federal and state reimbursement program requirements (e.g., Medicare and Medi-Cal), federal and state anti-kickback and physician self-referral laws (e.g., Stark and PORA), and provider and practitioner licensure and scope of practice requirements, privacy, and consent laws.

• Conduct regular and ongoing facility walk-throughs (e.g., day centers and clinics) in preparation for CMS, DHCS, DPHS, Department of Education, and other entity site visits/audits.

• Ensure all required licensing requirements are maintained/renewed as needed.

• Provide or coordinate annual trainings for staff regarding compliance such as HIPAA, Fraud Waste and Abuse, Fire and Safety.

• Assist with ongoing regulatory compliance audit preparation, including contracted site visits, audits, licensing, and other regulatory requirements.

• Requires excellent verbal, written, and presentation skills, including the ability to translate complex legal and regulatory requirements/issues into terms readily understood by management, line, and clinical personnel. Proficiency with PC and common software including word-processing, email, and internet-based legal and regulatory research is required.

• Ability to respond to questions with logic, clarity, calmness, and authority, leading to desired support of/actions by others.

• Requires well-developed skills in problem identification, analysis, resolution, organization, prioritization, timeliness, and attention to detail. Must be adept at complex project planning and management, with the ability to effectively delegate. Requires advanced auditing skills.

Additional Duties and Responsibilities

• Demonstrated skills in verbal communication and listening

• Excellent writing skills

• Participate in the development, implementation, and ongoing compliance monitoring of all business associate agreements and contracts to ensure privacy concerns, requirements, and responsibilities are addressed.

• Extensive familiarity with healthcare-relevant legislation and standards for the protection of health information.

• Assist with the identification, implementation, and maintenance of information privacy policies and procedures in coordination with the organization’s Compliance Committee.

• Perform other duties as assigned.

Job Requirements

Education Required:
Bachelor’s Degree, clinical degree, or clinical license required.

Certifications Required:
Certification in Healthcare Compliance or in the process of achieving certification – must be achieved within the first 90 days of hire.

Experience Required:

• Minimum of three (3) years of experience in a Corporate Compliance Program, Quality Assurance, and/or Risk Management.

• Experience in training and PowerPoint presentations

• Knowledge of Investigative Techniques.

Experience Preferred:

• Direct work experience in a project management capacity, including all aspects of process development and execution.

• Three (3) or more years in an audit, monitoring, and tracking environment.

• Basic understanding of healthcare program compliance requirements.

• Working knowledge of the Health Resources and Services Administration (HRSA) 330 Health Center Program requirements.

• Working knowledge of the HRSA 340B Drug Pricing Program.

• Oversight of corporate compliance policies, procedures, practice guidelines, and clinical protocol; including training, monitoring, conducting and documenting investigations, addressing violations, and monitoring corrective actions.

• Law degree preferred.

Equipment Used:
Computer, Office Equipment

Software Programs:
Nextgen and TruChart

Working Conditions and Physical Requirements (Sitting/Standing/Walking/Lifting/Noisy):

• Flexibility in schedule to meet project deadlines.

• Sitting for extended periods of time.

• Sufficient dexterity to effectively operate a computer keyboard and other related peripherals.

Universal Requirements

• Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.

HIPAA/Compliance

• Maintain privacy of all patient, employee, and volunteer information and access such information only on a need-to-know basis for business purposes.