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Organization TypePublic Interest
Years of Experience
Date Last Verified
Compliance Manager Duties: Manage compliance duties for all divisions of Care System, including Special Needs, Pediatric, Home Care, Rehab clinics, and the Health plan. Will involve audits, conflicts of interest, regulatory and legislative policies and procedures, annual compliance risk assessments, training on HIPAA, and working closely with the IT group. Will continuously research and analyze state and federal legislation, such as DC/MD/VA health care regulations and other regulatory developments to determine the impact on Care System.
Qualification and Experience
Qualifications: MBA or MS in Health Administration or a JD Degree. Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), or Accredited Healthcare Fraud Investigator (AHFI); Certified in Healthcare Compliance (CHC) or Certified Compliance and Ethics Professional (CCEP). 5+ yearsâ€™ experience with 2+ years of leading compliance audits and investigations. Experience interpreting and applying federal healthcare program laws and regulations. Working knowledge of Medicaid in an integrated health care delivery system (ideally a system with hospital, home health, and managed care entities). Critical thinking with excellent research and analytical skills. Proficiency in identifying, assessing, and reporting compliance gaps and/or internal controls, articulating appropriate recommendations, monitoring and testing for compliance.
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