Compliance Manager - Health Systems Solutions,

Navigant Research   •  

Miami, FL

Industry: Professional, Scientific & Technical Services


Less than 5 years

Posted 172 days ago

This job is no longer available.


The HSS Healthcare Compliance Manager will be relied upon to lead all efforts related to healthcare compliance at HSS, establishing and managing the daily activities of HSS’s Compliance Program. This position will be responsible for identifying, investigating, and resolving healthcare compliance issues relating to the delivery of revenue cycle management services including, but not limited to, compliance issues related to coding, billing, documentation, reimbursement, and privacy of patient data. The Compliance Manager will perform any and all compliance-related job duties assigned and will report to HSS’s Board of Directors.

Essential Job Functions:

  • Lead the design and implementation of the HSS Compliance Program in accordance with HHS-OIG Compliance Program guidelines.
  • Develop an annual Compliance Work Plan which will outline key milestones within each of the seven elements of the OIG Compliance Program guidelines.
  • Help establish and promote a culture of compliance within the HSS organization.
  • Respond to, and provide compliance-related advice with respect to, reported concerns and incidents in a timely manner.
  • Conduct or oversee compliance and HIPAA privacy investigations.
  • Develop and maintain a compliance incident database
  • Provide training to staff and management regarding the HSS Compliance Program. 
  •  Design, conduct, and oversee risk assessments.
  • Design, conduct, and oversee audits.
  • Chair HSS Compliance Committee.
  • Develop reports for HSS compliance activity.
  • Remain current of relevant regulatory publications and settlements.
  • Research pertinent state and federal regulations.

Duties and Responsibilities:

  • Manage day-to-day operations of the HSS Compliance Program using a systematic approach for identification and resolution of complex compliance problems.
  • Develop, execute and oversee audits that correlate with the HSS Audit Plan and OIG Guidance for Third-Party Medical Billing Companies pertaining to coding, billing, documentation, reimbursement, and privacy activities.
  • Periodically review and recommend updates to compliance policies, procedures and work plan to ensure relevance in providing guidance to management and employees.
  • Collaborate with other departments (e.g. Legal Department, Health Information Management, Internal Audit, Human Capital, Information Technology, etc.) to direct compliance issues to appropriate existing channels for investigation and resolution.
  • Collaborate with Client's Compliance Department on investigations and resolution of reported incidents, when appropriate.
  • Develop a reporting package to include appropriate dashboards and additional information for the HSS Compliance Committee, Board and/or governing bodies needed to assess the progress and effectiveness of the Compliance Program operations. 
  • Respond to questions or alleged violations of rules, regulations, policies, procedures, or client contractual requirements by evaluating and/or initiating an investigation as appropriate.
  • Report and escalate identified high risk issues immediately to HSS’s legal counsel, CEO and/or Board, as appropriate.
  • Monitor and coordinate compliance activities in conjunction with other program areas aligned with HSS compliance strategy and work plan.
  • Identify potential areas of compliance vulnerability and risk, facilitating corrective action plans for resolution. 
  • Develop effective compliance training programs to include new employee orientation, targeted education, and ongoing education for management and employees.
  • Ensure that proper reporting to an external agency of potential violations is referred to HSS’s legal counsel, CEO and/or Board, as appropriate.
  • Provide reports as directed and/or requested to HSS’s legal counsel, CEO and/or Board, as appropriate, on issues and concerns as listed above.
  • Other projects as assigned.


Education /Qualifications /Experience: 

  • Bachelor’s degree required.
  • CHC (Certified in Healthcare Compliance) required or attained within first year of employment.
  • 3-4 years of industry related experience in healthcare compliance, operations, quality or applicable experience in healthcare.
  • Demonstrated knowledge of the various payment systems including but not limited to MS-DRGs, APCs/APGs, and various managed care and capitated arrangements.
  • Knowledge of Stark, Anti-Kickback, HIPAA, HITECH and state privacy laws.
  • In-depth knowledge of healthcare compliance regulations including HIPAA privacy, coding, billing, exclusions, investigations, and corrective action plans.
  • Ability to identify, analyze, and investigate potential privacy incidents involving PHI.
  • Demonstrated ability to constructively and sensitively provide feedback to applicable parties regarding federal and state coding, medical documentation and compliance guidelines, audit risk results and risk areas.
  • Ability to work with and maintain confidentiality of physician, patient, and personnel data.
  • Ability to work effectively within a team environment.
  • Strong interpersonal and written and verbal communication skills.
  • Clear, concise, and persuasive writing and presentation skills.
  • Decisive and capable of exercising good judgment under pressure.
  • Ability to be flexible and to manage a diverse and demanding workload with minimal supervision.
  • Skilled in conflict resolution.
  • Very limited travel may be required.