Compliance Manager
Core
Leads day-to-day execution of healthcare compliance program for a value-based primary care model and Medicare Advantage arrangements.
Role type
Manager, healthcare compliance
Builds
Practical, effective compliance processes supporting a patient-first culture
Domain
Healthcare, Medicare Advantage, government payor regulations
Required skills
Medicare compliance, Medicare Advantage, fraud and abuse laws (Anti-Kickback, False Claims), HIPAA, exclusion and sanction screening, audit execution, compliance investigations, regulatory reporting
Preferred skills
Value-based care, risk-bearing arrangements, state Medicaid arrangements
Technologies
MedTrainer, OIG lists, SAM lists, CMS marketing requirements
Responsibilities
Maintain compliance policy library and Code of Conduct; deliver fraud and abuse training; administer compliance hotline and triage concerns; conduct exclusion and sanction screening; coordinate payer audits and attestations; execute audit and monitoring plans; conduct compliance investigations; support collaborative physician agreements
Seniority
Manager, hands-on execution with oversight partnership
