The Compliance Manager serves as a resource to assist the Compliance Officer with activities related to compliance auditing and monitoring, periodic compliance risk assessments and compliance/operational assessments. The Compliance Manager will help ensure compliance with all applicable rules and laws, as well as internal policies/procedures. He/she will be responsible for monitoring implementation of the annual compliance plan, conducting billing audits, investigating risk areas and implementing/monitoring corrective actions.
- Assist with developing and implementing the organization’s annual compliance program and work plan.
- Perform monitoring / auditing of potentially high-risk areas, prepare reports and help implement and monitor any required corrective actions.
- Maintains detailed and organized work papers and documentation to support activities and related work.
- Report violations of compliance or regulatory standards to duly authorized enforcement agencies as appropriate or required.
- Oversee internal reporting systems such as corporate compliance hotlines and inform employees about these systems.
- Keep informed regarding pending industry changes, trends, and best practices and will be able to provide analysis of potential impact on organizational processes.
- Conduct compliance investigations including interviews, data analysis and report writing and finalization of recommendations.
- Assist in the review and revision of agency policies and procedures.
- Work with other compliance staff in the planning and implementation of Medicaid audits.
- Must have experience with evaluating and identifying compliance risk areas.
- File appropriate compliance reports with regulatory agencies.
- Must be able to work on multiple projects simultaneously, ensuring completion of assignments within established time frames.
- Identifies and monitors new industry developments to assess their applicability.
- Oversee implementation of remediation and corrective action plans, resulting from audits, investigations, compliance reviews, and self-identified issues
- Makes oral or written presentation(s), as required.
- Bachelor’s degree required; Master’s degree preferred. (Major in Law, Health Sciences, Business Administration, Finance preferred).
- Strong working knowledge about healthcare compliance, privacy and clinical documentation.
- Understanding of Risk Management best practices.
- Proficiency in Microsoft Word, Excel, Access, and Power Point required, as well as Electronic Health Records.
- Formal compliance experience, preferred in a healthcare field, with at least four to six years of experience.
- Knowledge of Compliance program regulatory requirements, including Federal Sentencing Guidelines and OIG guidance.
- Strong analytical and problem-solving skills to identify root cause and resolve complex problems.
- Excellent communication, interpersonal and written skills are required.
- Must possess a thorough working knowledge of the healthcare industry, its laws and regulations.
- Must be able to work productively in a team-structured environment in a collaborative manner.
- Must show initiative and the ability to accomplish work independently with minimal supervision.
- Strong project management experience and ability to handle multiple priorities
- Understanding of HIPAA and state privacy laws
The above statements are intended to describe the general nature and level of work being performed by employees assigned this classification. They are not to be construed as an exhaustive list of all responsibilities and duties of personnel so classified