Healthcare Compliance Officer

SMARTFOX; New York (NY); On-site; USD 90,000 - 150,000; Full time

Job summary

SMARTFOX is seeking a Compliance Officer in the United States (New York) to support and run a comprehensive compliance program across HIPAA privacy, security, and breach notification requirements. This role involves auditing, risk assessments, and investigations while coordinating with multiple departments to ensure adherence to Medicare, Medicaid, and payer rules.

The candidate should have healthcare regulatory knowledge, strong analytical skills, and the ability to clearly communicate complex

Qualifications

• Working knowledge of healthcare regulation, HIPAA rules, and privacy/security controls.
• Strong analytical and investigative skills with attention to detail.
• Clear writing and communication, including explaining rules to non-experts.

Responsibilities

• Support and run the compliance program using the seven elements of an effective program (policies, training, monitoring, reporting, enforcement, response, and oversight).
• Monitor compliance with HIPAA Privacy, Security, and Breach Notification Rules; manage privacy incident investigations and breach risk assessments.
• Review billing, coding, and documentation for accuracy under Medicare, Medicaid, and commercial payer rules; including False Claims Act, Anti-Kickback Statute, and Stark Law exposure.
• Conduct internal audits, risk assessments, and focused reviews; track corrective action plans to completion.
• Manage the compliance hotline and reporting channels; investigate concerns fairly and confidentially with non-retaliation protections.

Education

Bachelor’s degree in Healthcare Administration or related field

Tools

GRC platforms (Compliance 360, MetricStream, Archer, LogicGate)

Job description

• Support and run the compliance program using the seven elements of an effective program (policies, training, monitoring, reporting, enforcement, response, and oversight)
• Monitor compliance with HIPAA Privacy, Security, and Breach Notification Rules, and manage privacy incident investigations and breach risk assessments
• Review billing, coding, and documentation for accuracy under Medicare, Medicaid, and commercial payer rules, including False Claims Act, Anti-Kickback Statute, and Stark Law exposure
• Conduct internal audits, risk assessments, and focused reviews, and track corrective action plans to completion
• Manage the compliance hotline and reporting channels, and investigate concerns fairly and confidentially, with non-retaliation protections
• Screen employees, providers, and vendors against OIG, SAM, and state exclusion lists, and manage credentialing and licensure checks
• Review vendor and business associate relationships, BAAs, and third-party risk
• Develop, update, and distribute policies and procedures, and make them readable and usable
• Design and deliver compliance training and awareness that staff actually remember
• Prepare for and support external audits and surveys (CMS, OCR, state agencies, RACs, UPICs, Joint Commission, and payers)
• Track regulatory changes, including price transparency, information blocking under the 21st Century Cures Act, and state privacy laws, and translate them into action
• Support compliance for telehealth, remote patient monitoring, and the responsible use of AI-assisted tools in clinical and administrative work
• Report program metrics and risks to the Compliance Committee and senior leadership
• Partner with legal, privacy, security, revenue cycle, clinical, and HR teams
• Level - Typical experience : What you’ll own
• Compliance Officer I - 0-2 years : Monitoring, audit support, hotline intake, exclusion screening, policy upkeep, and training logistics, learning with a dedicated mentor and a paid certification plan
• Compliance Officer II - 2-5 years : Owning audits and investigations, running risk assessments, advising departments, leading training, mentoring newer staff
• Senior Compliance Officer - 5+ years : Leading the program or a major domain, managing complex investigations and regulator interactions, advising executives and the board, developing the team

Promotion criteria are written down at every level, with regular career conversations. Many compliance professionals here have moved into privacy officer, compliance director, and Chief Compliance Officer roles.

What you bring

Must have :-

• Working knowledge of healthcare regulation, or strong related experience in healthcare operations, coding, auditing, law, or clinical work
• Understanding of HIPAA and the basics of how healthcare is billed and reimbursed
• Sound judgment, integrity, and discretion with sensitive matters
• Strong analytical and investigative skills, with attention to detail
• Clear writing and communication, including explaining rules to non-experts and holding firm when needed
• Bachelor’s degree in Healthcare Administration, Health Information Management, Business, Law, Nursing, or a related field, or equivalent experience. We value integrity and judgment over pedigree.
• Authorization to work in the US

Nice to have (not required) :-

• Certifications: CHC (Certified in Healthcare Compliance), CHPC, CCEP, CHPS, CPC, CCS, CIA, or similar (we’ll pay for them)
• Experience with audit, investigations, or internal controls in a healthcare setting
• Knowledge of Medicare Advantage, Medicaid managed care, or specific settings such as hospitals, physician groups, behavioral health, home health, skilled nursing, or labs
• Familiarity with GRC platforms (such as Compliance 360, MetricStream, Archer, or LogicGate) and privacy tools
• Experience with the Office of Inspector General’s compliance program guidance
• Paralegal, JD, nursing, or health information management background
• Experience in [hospitals, health systems, payers, physician groups, behavioral health, post-acute care, health tech, etc.]
• Second language, particularly Spanish, an asset for patient and staff communication [if applicable]