Compliance Manager

Herself Health; United States; Híbrido; USD 90 000 - 105 000; Tempo integral

Resumo da oferta

Herself Health is seeking a Compliance Manager to lead the day-to-day execution of our healthcare compliance program, supporting value-based primary care and Medicare Advantage arrangements. You will maintain policies, training, investigations and regulatory reporting to sustain a patient-first culture.

The role partners with the fractional Compliance Officer and General Counsel, coordinating with clinical and People leaders to build practical compliance processes and ensure ongoing compliance

Qualificações

• Bachelor's degree or equivalent in a related field or experience.
• Hands-on healthcare compliance experience involving Medicare, Medicare Advantage or other complex government payor requirements.
• Working knowledge of federal fraud and abuse requirements, including the Anti‑Kickback Statute, False Claims Act, Civil Monetary Penalties Law and physician self‑referral law.
• Working knowledge of HIPAA privacy and security requirements.

Responsabilidades

• Maintain the compliance policy library with annual reviews, version control, approvals and workforce publication; coordinate scope-of-practice requirements.
• Maintain the Code of Conduct and track annual attestations from workforce members, contractors and vendors.
• Serve as the operational compliance point of contact; manage the annual work plan, risk assessment, dashboards and reporting materials.
• Deliver and document compliance and fraud, waste and abuse training; track completion and address gaps.
• Administer the MedTrainer compliance hotline and other reporting channels; triage concerns and log cases.
• Conduct exclusion and sanction screening at hire and monthly; coordinate with People Team on accountability.
• Coordinate Medicare Advantage attestations, payer audits and CMS marketing/communication compliance.
• Execute the audit and monitoring plan; report findings and coordinate corrective actions.
• Conduct investigations with the GC and clinical leadership as needed.
• Support physician agreements and regulatory requirements in coordination with clinical partners.

Conhecimentos

Healthcare compliance

Medicare knowledge

HIPAA expertise

Regulatory reporting

Formação académica

Bachelor's degree or equivalent

Ferramentas

MedTrainer

CMS portals

Descrição da oferta de emprego

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, elevate 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, including 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 discriminate based on race, religion, color, national origin, gender identity or expression, age, marital status, veteran status, disability status, parental status, political affiliation, or any other status protected by federal, state, or local laws.

Compliance expectations

All employees of Herself Health are expected to fully understand and abide by the practice's compliance policies and procedures. Employees are provided training upon hire and annually and regularly notified of changes as needed. It is expected that all employees will report any suspected violations of any federal or state laws to their direct supervisor, Human Resources, or the Compliance Officer.