Bachelor's degree in Business Administration, Healthcare Administration, or related field.
10+ years of relevant experience, with at least 5 years in healthcare, preferably in a clinical lab.
5+ years of management experience in healthcare compliance.
Ability to work independently in a fast-paced startup environment.
Strong communication skills for effective cross-functional collaboration.
Familiarity with healthcare regulations and billing/coding standards.
Proficiency in MS Office and ability to adapt to third-party software.
Responsibilities
Operationalize healthcare regulatory guidance into internal policies and procedures.
Serve as a compliance resource for organizational teams, offering clear guidance on policies.
Support the development and implementation of compliance education materials and sessions.
Develop and manage the healthcare Compliance program with internal stakeholders.
Lead the execution of compliance risk assessments and annual audit plans.
Conduct audits to identify compliance vulnerabilities and collaborate on action plans.
Assist with internal and external audits, ensuring regulation compliance.
Benefits
Hybrid/remote work environment.
Focus on professional growth with exposure to various compliance areas.
Opportunity to make significant contributions in a dynamic startup setting.
Limited travel requirements.
Strong team collaboration opportunities.
Full Job Description
KEY RESPONSIBILITIES
Operationalize healthcare regulatory guidance into actionable internal policies and procedures, draft, revise and maintain policies and procedures that reflect current regulatory requirements, operational realities and industry best practices.
Serve as a key compliance resource to teams across the organization, responding to compliance-related inquiries and providing clear, written actionable guidance on how to apply internal policies and regulatory requirements in day-to-day operations.
Support the development, implementation and monitoring of healthcare compliance education materials; conduct education sessions and help identify opportunities to reinforce policy adoption and awareness across teams.
Develop and administer the healthcare Compliance program through coordination with the Sr. Director, Compliance, internal stakeholders, and best practices.
Lead the development and execution of the Company's healthcare compliance risk assessment and work plan, identifying key areas of risk and developing an annual audit plan.
Conduct and support retrospective and prospective healthcare compliance audits and spot checks to identify potential gaps or areas of compliance vulnerability. Collaborate with teams cross-functionally to develop appropriate action plans that address audit findings and introduce controls likely to prevent non-compliance performance.
Assist in collaborating with internal and external auditors during healthcare regulatory audit and monitoring activities.
Contribute to the preparation and execution of quarterly Compliance Committee meetings, including development of pre-read materials, tracking open issues, and surfacing risk themes or emerging compliance trends for leadership discussion.
Maintain professional and technical knowledge of healthcare compliance legal and regulatory requirements, including subject matter expertise in Medicare and state Medicaid program billing requirements, federal/state fraud, waste and abuse laws (e.g. Stark, EKRA, Anti-Kickback) and business relationship laws (Anti-Lobbying, FCRP, etc,).
Oversee and manage Baylor Genetics' confidential and anonymous Hotline, to include proper routing of complaints, monitoring and ensuring timely completion of investigations and preparing metric reports for the Compliance Committee and other members of management.
Organize and manage administrative tasks involved in the oversight of key healthcare compliance risk areas.
Oversee and manage exclusion screenings to ensure compliance with regulations and contractual requirements.
Support compliance considerations in product and operational development, partnering with cross-functional teams to ensure new initiatives, workflows or rollouts align with internal policy expectations.
Perform other duties as assigned to support team and organizational objectives.
Comply with all company policies, procedures, and applicable regulatory requirements.
QUALIFICATIONS
Required
Bachelor's degree in Business Administration, Healthcare Administration, or a related field.
10+ years relevant experience, with at least 5 years in the healthcare industry, preferably in a clinical laboratory environment.
5+ years experience managing others, preferably in a healthcare compliance setting.
Adaptable and able to function independently, with little need for oversight, in a fast paced, highly fluid startup environment.
Ability to timely manage many high-risk, high-pressure projects/issues at once and prioritize effectively based on risk.
Strong communication skills with proven track record of success working with cross functional teams.
Working knowledge of applicable healthcare regulations and state and federal laws.
Working knowledge of third-party billing and coding standards for laboratory testing.
Computer skills and high competence with MS Office (Word, Excel, PowerPoint) and ability to easily adapt to third-party software solutions.
Equivalent combination of education and experience may be considered.
Preferred:
Active compliance certification; CHC, CCEP preferred.
COMPETENCIES
Ability to evaluate complex legal concepts and apply them to the Organization's business practices.
Ability to prioritize projects and assigned work to meet changing deadlines.
Attention to detail to deliver error-free and quality product.
WORK ENVIRONMENT
Location: Hybrid / Remote
Frequently required to sit
Frequently required to stand
Frequently required to utilize hand and finger dexterity
