SUMMARY:
The Compliance Manager supports the development, implementation, monitoring, and continuous improvement of the compliance program for a nationwide physician group. Reporting to the Chief Compliance Officer, this role helps ensure compliant physician practice operations, billing and coding, payer requirements, privacy obligations, vendor relationships, and related policies across a multi-state practice environment.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Program Development and Continuous Improvement
- Develop, maintain, and update compliance policies, procedures, standards of conduct, training materials, and related program documents.
- Design, deliver, and track compliance education for physicians, advanced practice providers, employees, contractors, practice leaders, executives, and governing body members.
- Prepare compliance reports, dashboards, and updates for the Chief Compliance Officer, senior leadership, compliance committee, and governing body, as directed.
Audit, Monitoring, and Compliance Initiatives
- Manage day-to-day compliance operations, including risk-based auditing, monitoring, investigations, corrective action oversight, reporting, issue tracking, and practice-level support.
- Lead audit scoping, sampling, data requests, fieldwork follow-up, findings validation, management response tracking, and communication of audit results.
- Lead compliance initiatives such as documentation improvement, billing and coding education, policy implementation, regulatory readiness, privacy process improvements, and dashboard development.
- Support external audits, regulatory inquiries, payer reviews, and government investigations in coordination with legal counsel and leadership.
Investigations and Issue Management
- Receive, triage, document, and investigate compliance concerns, hotline reports, privacy incidents, and potential violations of policy or law.
- Manage corrective action plans arising from audits, monitoring activities, investigations, payer reviews, and regulatory inquiries; track remediation milestones, validate completion, and escalate overdue or ineffective corrective actions to the Chief Compliance Officer.
- Promote a non-retaliatory reporting environment and reinforce the organization’s commitment to ethical, lawful, and patient-centered operations.
Regulatory Compliance
- Monitor compliance with applicable healthcare laws and regulations affecting physician practices and multi-state operations, including HIPAA, HITECH, Stark Law, the Anti-Kickback Statute, False Claims Act, CMS requirements, Medicare and Medicaid program rules, payer requirements, and state-specific healthcare regulations.
- Recommend updates to policies, workflows, provider education, training, and internal controls based on regulatory or operational changes.
- Maintain accurate and confidential records of compliance activities, audits, investigations, training, disclosures, and corrective actions.
Required Skills
- Working knowledge of healthcare compliance program elements, regulatory requirements, privacy and security obligations, fraud and abuse laws, and payer compliance expectations.
- Experience managing audits, investigations, risk assessments, compliance initiatives, corrective action plans, and remediation tracking.
- Strong project management, communication, analytical, and stakeholder collaboration skills.
- Ability to build trust and collaborate across departments and leadership levels.
- Knowledge of professional fee billing, documentation, coding, provider enrollment, credentialing, privacy, and risk management.
Education and Experience:
- Bachelor’s degree in Business Administration, Healthcare Administration, Risk Management, Legal Studies, or related field required.
- Healthcare compliance certification such as Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Certified Professional Coder (CPC), Certified Internal Auditor (CIA), or equivalent credentials.
- Minimum of five years of experience in healthcare compliance, physician practice operations, professional fee billing and coding, regulatory affairs, auditing, privacy, revenue cycle, risk management, or a related function.
- Familiarity with OIG compliance guidance, CMS program integrity expectations, accreditation standards, and state healthcare regulatory requirements.
Pay: $110,000.00 - $130,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: Hybrid remote in Miramar, FL 33027
