Healthcare Compliance Manager
J
JobgetherHealthcare technology
Based in the United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- At least 5 years of experience in healthcare compliance, particularly in Medicare billing, HIPAA, post-acute care, or remote patient monitoring.
- Required Skills
- HIPAA
Requirements
- At least 5 years of experience in healthcare compliance, particularly in Medicare billing, HIPAA, post-acute care, or remote patient monitoring.
- CHC certification is required or must be obtainable within 12 months of hire.
- CHPC certification is a plus.
- Working knowledge of CPT codes 99453–99470, CMS Physician Fee Schedule Final Rules, OIG Work Plan requirements, and Medicare Administrative Contractor audit processes.
- Knowledge of the Anti-Kickback Statute and Stark Law safe harbors.
- Strong understanding of healthcare privacy and security obligations, regulatory compliance frameworks, and healthcare billing controls.
- Experience writing and maintaining SOPs, audit documentation, compliance logs, and corrective action records.
- Experience conducting internal audits, investigating compliance concerns, and coordinating remediation.
- Ability to design and deliver compliance training and maintain training and attestation records.
- Proficiency in Microsoft 365 is required; familiarity with healthcare compliance platforms is preferred.
- A bachelor's degree is required; a degree or background in healthcare administration, law, or a clinical discipline is preferred.
- Ability to manage multiple compliance priorities, monitor changing regulations, and maintain accurate records while meeting deadlines.
Responsibilities
- Manage monthly billing compliance reviews, validating CPT code selection, data-day thresholds, time-counting rules, and Medicare billing limits.
- Track CMS, Medicare Administrative Contractor, and OIG regulatory updates and communicate material changes to leadership.
- Serve as the HIPAA Compliance Officer and oversee Security Risk Assessments, privacy notices, and Business Associate Agreements.
- Lead privacy and security breach investigations and coordinate required notifications with external legal counsel.
- Maintain the SOP library, coordinate annual reviews, and track approvals, version histories, and change logs.
- Conduct monthly random-sample claims audits covering at least 10% of submitted claims, document findings, and implement corrective actions.
- Develop and deliver annual compliance training and maintain training records and compliance reports.
- Track overpayments, coordinate investigations and refunds within the applicable 60-day deadline, and consult legal counsel on systemic issues.
- Monitor state nurse practitioner practice act changes and obligations associated with RHTP, THRIVE, and NIH grants.
- Review partner and vendor agreements for Anti-Kickback Statute compliance and coordinate annual contract reviews.
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