Remote Healthcare Compliance Manager (Medicare & HIPAA)

Herself Health; Nashville (TN); Hybrid; USD 90,000 - 105,000; Full time

Benefits offered by this job

MedTrainer compliance hotline

Job summary

Herself Health is seeking a Compliance Manager to lead day-to-day healthcare compliance for our value-based primary care model and Medicare Advantage arrangements. You will maintain policies, training, screening and regulatory reporting, partnering with our fractional leadership to build practical compliance processes that support patient-first care.

Remote or hybrid work is available with periodic in-person collaboration; occasional work outside standard hours for investigations and regulatory

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.

Responsibilities

• 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.

Job description

Herself Health is seeking a Compliance Manager to lead day-to-day healthcare compliance for our value-based primary care model and Medicare Advantage arrangements. You will maintain policies, training, screening and regulatory reporting, partnering with our fractional leadership to build practical compliance processes that support patient-first care.

Remote or hybrid work is available with periodic in-person collaboration; occasional work outside standard hours for investigations and regulatory