Compliance Manager

herselfhealth; United States; Hybrid; USD 90.000 - 105.000; Vollzeit

Zusammenfassung

Herself Health is seeking a Compliance Manager to lead day-to-day execution of our healthcare compliance program supporting value-based primary care and Medicare Advantage arrangements. This hands-on role maintains policies, audits, training and regulatory reporting while collaborating with leadership.

You will work remotely or in hybrid settings, with periodic in-person meetings. The ideal candidate has a Bachelor's degree and hands-on Medicare compliance experience, plus HIPAA and

Qualifikationen

• Hands-on healthcare compliance experience
• Experience with Medicare/MAC or related payor requirements
• Knowledge of federal fraud and abuse rules (e.g., AKS, False Claims Act) and privacy rules (HIPAA).

Aufgaben

• Maintain and update the compliance policy library with annual reviews and approvals.
• Maintain annual attestations and Code of Conduct; track workforce and vendor compliance.
• Manage risk assessments, dashboards, agendas and Board reporting materials.
• Deliver compliance training at hire and annually; close gaps with targeted education.
• Coordinate regulatory reporting, audits, investigations and hotline operations.
• Perform exclusion and sanction screenings at hire and monthly; collaborate with People Team.
• Support Medicare Advantage attestations, payer audits and CMS-related communications.
• Execute the audit/monitoring plan; report findings and drive corrective actions.
• Lead investigations with counsel and clinical leadership as needed.

Kenntnisse

Healthcare compliance

Medicare compliance

Regulatory knowledge

HIPAA compliance

Ausbildung

Bachelor's degree or equivalent

Jobbeschreibung

Compliance Manager

Job Description

Employment type: Full-time | Level: Manager

Location: Remote / Hybrid | Reports to: Chief People Officer

Compensation: $90,000 - $105,000, depending on experience

Who we are

Herself Health provides primary care designed for women 65 and older. Our model addresses the needs of women later in life, including post-menopausal care, bone health, weight management, and mental, social and emotional well-being. We bring personalized care and meaningful relationships to the communities we serve.

Our Mission

We deliver exceptional, compassionate, and high value advanced primary care for the unique needs of maturing women, empower HER to live a healthier, fuller life.

How you will work

We look for colleagues who put patients first, collaborate across teams and take ownership of their work. You bring curiosity, sound judgment and a willingness to learn, using feedback and data to improve how we care for patients and support one another.

Our values guide how we work, make decisions and show up for our patients and one another. We bring them to life through our everyday actions:

• Her, First - We center every decision on the women we serve.
• Curious, Always Learning - We ask questions, seek feedback and keep improving.
• Own it, Act - We take responsibility, follow through and solve problems.
• Together, Unstoppable - We share knowledge and support each other to deliver better care.

About the role

The Compliance Manager leads day-to-day execution of Herself Health's healthcare compliance program, supporting our value-based primary care model and Medicare Advantage arrangements. This hands-on role maintains compliance policies, monitoring and audit activities, workforce training, screening, investigations and regulatory reporting. The Compliance Manager partners with the fractional Compliance Officer on program priorities and oversight, the fractional General Counsel on legal matters, and clinical and People leaders to build practical, effective compliance processes that support a patient-first culture.

What you will do

• Maintain the compliance policy library, including annual reviews, version control, approvals and workforce publication; coordinate state-specific scope-of-practice and collaboration-agreement requirements.
• Maintain the Code of Conduct and track annual attestations from workforce members, contractors and applicable vendors.
• Serve as the operational compliance point of contact; maintain the annual work plan, risk assessment, committee dashboards, agendas, minutes and Board/Committee reporting materials.
• Deliver and document compliance and fraud, waste and abuse training at hire and annually; track completion, escalait gaps and develop targeted role-specific education.
• Administer the MedTrainer compliance hotline and other reporting channels; triage concerns, maintain case logs and communicate company policies.
• Conduct and document required exclusion and sanction screening at hire and monthly thereafter, including OIG, SAM and applicable state lists; partner with the People Team on consistent accountability.
• Coordinate Medicare Advantage downstream-entity attestations, payer audits and data requests; monitor patient outreach and materials for applicable CMS marketing and communications requirements.
• Execute the audit and monitoring plan, report findings and progress to the fractional Compliance Officer and compliance committee, and coordinate corrective actions.
• Conduct and document compliance investigations with the fractional general counsel, clinical leadership and outside counsel as needed.
• Support collaborative physician agreements and other regulatory requirements in coordination with clinical and interdisciplinary partners.

What you bring

Required qualifications

• Bachelor's degree or an equivalent combination of education and directly relevant experience.
• Hands-on healthcare compliance experience involving Medicare, Medicare managed care, Medicare Advantage or other complex government payor requirements.
• Working knowledge of federal fraud and abuse requirements include the Anti-Kickback Statute, False Claims Act, Civil Monetary Penalties Law and physician self-referral law.
• Working knowledge of HIPAA privacy and security requirements.

Preferred qualifications

• Experience with value-based or risk-bearing Medicare Advantage or state Medicaid arrangements.

Location and schedule

Work arrangement: Remote or hybrid, with periodic in-person collaboration at Herself Health clinics and external meetings.

Schedule: Full-time; occasional work outside standard hours for time-sensitive investigations, breach assessments or regulatory deadlines.

Travel: Periodic travel to clinic locations, payer meetings and audits. Role involves handling sensitive information, including protected health information and personnel matters.

Equal opportunity

We support Equal Employment Opportunities (EEO). We are committed to an inclusive workplace. We do not discr