JOB SUMMARY
The Compliance Manager contributes to Conifer Health’s (Conifer) purpose by providing both strategic and day-to-day leadership to the compliance program designed to ensure Conifer fully complies with its Standards of Conduct and all applicable laws and regulations as it relates to value-based care. The Compliance Manager will lead and support compliance program initiatives and provide leadership for a variety of projects as it relates to the value based care programs.
Develops, implements, and oversees the compliance program; including (1) maintaining and expanding visibility of the compliance program at all levels within the organization (2) ensuring there is an effective compliance program and oversight in place to remain compliant with all local, state, and federal healthcare rules, regulations and adimistrative requirements and (3) collaborating with team members to support programmatic efforts.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
Conifer Value Based Care Compliance Program Operations
• Coordinates audit responses and corrective actions as it relates to the Compliance Program.
• In conjunction with Chief Compliance Officer, coordinates attestation related to Conifer Value-Based Care Compliance Program oversight of vendors as it relates to CMS compliance program requirements.
• Supports Compliance Investigations Officers as Subject Matter Expert in the process for investigating and addressing internal/external complaints regarding regulatory requirements, including validation of remedial activities, as applicable.
• Oversees the development and implementation of compliance policies and procedures related to Conifer Value-Based Care.
• Assists in monitoring and interpreting regulatory changes related to Conifer Value-Based Care. Supports efforts to respond to new or changing regulations, including but not limited to assessing impact of regulations from a compliance program perspective in conjunction with leadership and affected departments.
• Reporting of incidents as required by Client Plan contracts, including concerns related Fraud, Waste and Abuse, and Privacy Breaches, in coordination with Leadership
• Reduces organization risk by identifying risks related to Conifer Value-Based Care and manages annual work plan items to address identified risks.
• Contributes to the annual compliance monitoring plan and the components related to Conifer Value-Based Care activities, as needed.
• Develops and implements key compliance monitoring activities related to third-party oversight, as required by CMS.
• Attend key operational meetings to provide compliance guidance, matter trending and assess opportunities for proactive risk management
• Act as subject matter expert in the review of on-going and ad hoc compliance program documents, policies and education to ensure Conifer Value-Based Care risk areas are adequately represented.
• Leads and/or participates in organizational projects related to the design, implementation, revision or maintenance of process and systems that promote compliance.
• Serves as a business partner, internal expert and advisor in compliance matters
• Collaborates with key leadership, team members, contractors and other stakeholders throughout Conifer to promote a culture of compliance.
Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.
KNOWLEDGE, SKILLS, ABILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ability to work independently with little supervision and seek guidance as needed to clarify assignments or request for information.
- Excellent communication, customer service and time-management skills
- Strong team-building and development skills
- Possess basic business skills, an understanding of general compliance operations and department goals in the healthcare environment.
- Proficient with various desktop applications such as Microsoft Excel, Word, PowerPoint and/or Access.
- Intermediate knowledge of relational database management systems
- Must be a team player - Always willing to help in whatever way possible and go the extra mile to get the job done.
- Intuitive and skilled at problem solving in anticipation of team member and client request
- Have the ability to make logical correlations between data points to determine if analysis is accurate
- Detail oriented, meticulous and accurate in completing tasks on time.
EDUCATION / EXPERIENCE
Include minimum education, technical training, and/or experience preferred to perform the job.
- Bachelor degree in Business, Health Care Administration; Juris Doctorate or related field or equivalent years of related Manager experience required.
REQUIRED CERTIFICATIONS/LICENSURE
Include minimum certification required to perform the job.
- Certified Healthcare Compliance (CHC) is preferred
- Managed Care experience preferred
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to work in sitting position, use computer and answer telephone
- Ability to Travel
- Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Office Work Environment
- Hospital Work Environment
- Remote Office Work Environment
TRAVEL
- Up to 10%
Compensation and Benefit Information
Compensation
- Pay: $89,440 - $110k annually. Compensation depends on location, qualifications, and experience.
- Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
- Management level positions may be eligible for sign-on and relocation bonuses.
Benefits
Conifer offers the following benefits, subject to employment status:
- Medical, dental, vision, disability, life, and business travel insurance
- Paid time off (vacation & sick leave) – min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked.
- 401k with up to 6% employer match
- 10 paid holidays per year
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance.
- For Colorado employees, Conifer offers paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.
As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step!
- Participates in and contributes to the development of the Annual Compliance Work Plan and related documents and assists in the execution of assigned Work Plan items.
- Manages the organizational OIG/GSA exclusion screening process.
- Manages the organizational Conflict of Interest process including assignment, monitoring for completion and coordination of review of disclosed activities.
- Assists in the monitoring of education assignment and completion for both annual and newly on-boarded staff to support complete and timely education.
- Manages the organizational Quarterly Compliance Certification process including process enhancement, completion and coordination of disclosed responses.
- Assists with general compliance program project management to support thoughtful and timely execution.
- Assists in the review or revision of compliance department policies and procedures.
- Partners and collaborates with leadership and business partners to communicate and integrate the compliance program throughout the organization.
- Provides ongoing compliance-related support to team members and key decision makers, including compliance committee activities, Client requests organization of data, preparation of compliance presentation materials, and additional tasks as needed.
- Bachelor's degree in business, healthcare administration, or a related field. Master's degree is preferred.
- Minimum of 5 years of experience in compliance management, preferably in the healthcare industry.
- In-depth knowledge of relevant laws, regulations, and standards, such as HIPAA, Stark Law, Anti-Kickback Statute, and False Claims Act.
- Strong understanding of compliance principles, methodologies, and best practices.
- Experience in developing and implementing compliance programs and policies.
- Familiarity with compliance auditing, risk assessment, and investigation techniques.
- Excellent communication and interpersonal skills to effectively interact with employees at all levels of the organization.
- Strong analytical and problem-solving abilities, with the ability to evaluate complex situations and recommend appropriate solutions.
- Ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines.
- Proficiency in using compliance management software and other relevant tools.
- Relevant certifications in compliance, such as Certified Compliance and Ethics Professional (CCEP), Certified in Healthcare Compliance (CHC), or Certified Professional Compliance Officer (CPCO), are highly desirable.
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