The Compliance Manager reports to the General Counsel (GC) and is responsible for developing comprehensive and strategic compliance programs for physician practice healthcare settings. This role will also collaborate with senior leadership, HR, Finance, operations, and clinical quality to develop and maintain practices, policies, and guidance necessary for a secure compliance function.
- Lead the development, implementation, evaluation, and management of effective and best practice compliance programs within physician practice healthcare settings.
- Conduct regulatory research and analysis around federal health care regulations including the False Claims Act, Anti-kickback Statute, Stark Laws, HIPAA, Affordable Care Act, and other state and federal laws and regulations.
- Assess current state and implement processes and technology to ensure the mitigation and prevention of privacy/HIPAA violations.
- Assists with compliance projects, audits, training, and investigations as necessary while partnering closely with the clinical, HR, and operations teams.
- Identify and create new Compliance- and Privacy-related policies and controls and ongoing audits of controls
- Leads the compilation of information, drafting of clear/specific policy and documentation required for internal and external monitoring and auditing purposes
- Carry out risk analysis on healthcare compliance, discover areas of potential compliance risk and vulnerability, and create and implement solutions to eliminate the potential risks
- Assess and be informed about current legislation and enforcement issues affecting the healthcare industry, as well as compliance best practices
- Work closely with others in related departments, including legal, HR, IT, Regulatory, Security, Risk and Finance for effective investigation, resolution, reporting, and remediation of compliance issues
- Prepare report for management on incidents, investigations, and all compliance issues
- Serve as the company's subject matter expert for operational compliance matters for both internal and external stakeholders
- Manage Corporate and Malpractice Insurance Programs to include D&O, GL, Property, Crime, Fiduciary, EPL, Cyber, Malpractice
- Monitors claims activity and incidents for all lines of insurance and assists in coordinating quarterly claims calls with broker, attorneys, and consultants
- Communicates compliance matters and malpractice claims developments with the Board of Directors and Compliance Committee
- Solicits and coordinates renewal and exposure information from physicians, corporate staff and fields insurance program and responds to claims questions and resolutions
- Assists finance with allocation of corporate business and malpractice insurance policy premiums, develops annual budget, and communicates to stakeholders
- Oversee the coordination and implementation of client corrective action plans for compliance, regulatory and delegated areas
- 5+ years of experience working in the healthcare industry with compliance, insurance programs, regulatory, or related subject matter areas
- Attention to detail and ability to handle multiple projects simultaneously and adjust to changes quickly while meeting deadlines.
- Strong organizational and communication skills and demonstrated competency in change management and innovation in the compliance space.
About Advantia Health:
Advantia is transforming healthcare for all women - helping them get healthier, reducing unnecessary costs, and setting a higher standard for experience. Compassion and value inspire everything we do. We take time to listen, answer questions completely, and offer helpful technology between visits so our patients are always at ease. Alongside great care, Advantia is pioneering care models that align incentives with the best interests of women and their families.
Please note: Advantia Health is dedicated to providing unparalleled healthcare to our customers by employing the most highly-qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 vaccination is a required condition of employment.