Healthcare Compliance Manager

Accountabilities

• Medicare and remote patient monitoring billing compliance: Manage monthly billing compliance reviews, validating CPT code selection, data-day thresholds, mutual exclusivity requirements, time-counting rules, and applicable Medicare billing limits before claims are submitted.

• Regulatory monitoring: Track updates to CMS Physician Fee Schedule Final Rules, Medicare Administrative Contractor Local Coverage Determinations, and relevant Office of Inspector General (OIG) Work Plan items. Communicate material regulatory changes to leadership within established timelines.

• HIPAA privacy and security: Serve as the designated HIPAA Compliance Officer, oversee annual Security Risk Assessments, maintain the Notice of Privacy Practices, and manage Business Associate Agreement requirements for vendors and skilled nursing facility partners.

• Incident response: Lead privacy and security breach investigations, coordinate required notification processes, and work with external legal counsel on reportable incidents.

• Policies and standard operating procedures: Maintain and update the organization's standard operating procedure (SOP) library, ensuring regulatory changes are reflected promptly. Coordinate annual reviews, obtain required executive approvals, and maintain version histories and change logs.

• Internal audits and corrective actions: Conduct monthly random-sample claims audits covering at least 10% of submitted claims. Verify documentation completeness, coding accuracy, patient consent, and care-plan compliance. Document findings, escalate recurring issues, and implement and verify corrective actions within agreed timelines.

• Compliance training and attestations: Develop, deliver, and track annual compliance training for clinical, billing, and administrative employees. Cover Medicare billing requirements, HIPAA, the Anti-Kickback Statute, and the OIG's remote patient monitoring compliance framework. Maintain training records and prepare annual compliance reports for leadership.

• Overpayment management: Maintain the Overpayment Tracking Log and ensure identified overpayments are investigated, classified as isolated or systemic, and refunded within the applicable 60-day statutory deadline. Coordinate refund submissions with the Billing Manager and consult legal counsel on systemic issues before refunds are made.

• State and government program compliance: Monitor relevant state nurse practitioner practice act changes across Texas, Ohio, Pennsylvania, Florida, New York, and Missouri, as well as potential expansion markets. Track applicable obligations associated with RHTP, THRIVE, and NIH grants as new government programs are pursued.

• Contract and Anti-Kickback Statute compliance: Review skilled nursing facility partner and vendor agreements against established Anti-Kickback Statute checklists before execution. Escalate fair market value or referral-contingency concerns to leadership and legal counsel, maintain executed contract records, and coordinate annual contract reviews.

Requirements:

• At least 5 years of experience in healthcare compliance, particularly in Medicare billing, HIPAA, post-acute care, or remote patient monitoring.

• Certified in Healthcare Compliance (CHC) certification, required or obtainable within 12 months of hire.

• Certified in Healthcare Privacy Compliance (CHPC) certification is a plus.

• Working knowledge of CPT codes 99453–99470, CMS Physician Fee Schedule Final Rules, OIG Work Plan requirements, Medicare Administrative Contractor audit processes, and Anti-Kickback Statute and Stark Law safe harbors.

• Strong understanding of healthcare privacy and security obligations, regulatory compliance frameworks, and healthcare billing controls.

• Demonstrated ability to write, maintain, and manage standard operating procedures, audit documentation, compliance logs, and corrective action records.

• Experience conducting internal audits, investigating compliance concerns, and coordinating remediation activities.

• Ability to design and deliver compliance training to both clinical and non-clinical teams and maintain accurate training and attestation records.

• Strong written and verbal communication skills, sound judgment, attention to detail, and the ability to communicate regulatory requirements clearly to different stakeholders.

• Proven ability to work cross-functionally with leadership, billing teams, clinical personnel, operational teams, and external legal advisors.

• 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 statutory and internal deadlines.

Benefits:

• Full-time employment in a healthcare technology organization focused on remote patient monitoring and patient safety.

• Opportunity to contribute to compliance practices supporting AI-powered healthcare solutions and evolving care delivery models.

• Collaboration with healthcare, clinical, billing, operational, and executive stakeholders.

• Opportunity to build, manage, and continuously improve a comprehensive healthcare compliance program.

• Salary and additional benefits were not specified in the provided job description.

• Remote work is indicated in the original listing; specific eligibility, location restrictions, and working-hour arrangements should be confirmed during the recruitment process.