Compliance Program Manager

We are currently seeking a Compliance Program Manager to join our team of highly qualified professionals that share our mission of Empowering Children to Conquer their World! Pediatrics Plus is a highly collaborative pediatric healthcare provider. We are committed to helping children succeed in all stages of life through evidence-based therapy (Applied Behavior Analysis, Occupational Therapy, Physical Therapy, and Speech Therapy) and developmental preschool services, state of the art facilities, specialized equipment, family support and education, and community investment.  

What we offer:

• Competitive Pay
• 15 Days of Paid Time Off
• Medical, Dental, & Vision Insurance
• Company Discounts & Incentives
• Professional Development and Leadership Growth Opportunities
• State of the Art Facilities & Technology

What you will do: 

The Compliance Program Lead will be instrumental in planning, implementing, maintaining, and administering a system-wide compliance program for Pediatrics Plus, ensuring adherence to healthcare regulations, including HIPAA, billing codes, and internal policies. They will proactively monitor potential compliance risks, develop and implement preventative measures, and foster a culture of compliance to protect the practice, its clients, and stakeholders. The Compliance Program Lead will empower teams to prioritize compliance as a business enabler, promote ethical behavior at all levels, and ensure seamless integration of compliance practices into day-to-day operations. The Compliance Program Lead will also provide strategic guidance to ensure compliance practices align with the growth goals of Pediatrics Plus while mitigating risk.

Regulatory Compliance and Governance

• Ensures adherence to all healthcare regulations, including HIPAA, HITECH Act, OSHA, Stark Law, and federal/state requirements for pediatric practices.
• Under the guidance and direction of the Chief Legal Officer and Compliance Committee, the Compliance Program Lead will develop and implement strategies to ensure ongoing compliance with evolving healthcare laws and regulations.
• Coordinates internal and external compliance audits and inspections and as designated by the Chief Legal Officer, serves as a point of contact with regulatory agencies.

Compliance Program Administration

• Under the direction of the Chief Legal Officer and Compliance Committee, develops, maintains, monitors, and continuously improves a comprehensive compliance framework, including policies, procedures, and standards aligned with healthcare regulations and best practices.
• Establishes governance structures to ensure compliance initiatives are effectively monitored and reported.
• Conducts regular evaluations of compliance programs to identify areas for improvement.
• Assists the Chief Legal Officer in developing the annual Compliance Work Plan and is responsible for coordinating and tracking implementation of approved work plan activities.

HIPAA and Data Privacy Oversight

• Develops policies to safeguard Protected Health Information (PHI) and ensure full compliance with HIPAA and other privacy regulations.
• Leads investigations into data breaches or privacy violations and implements corrective actions.
• Conducts regular team member training on privacy practices, data security, and the importance of protecting patient information.

Billing, Coding, and Documentation Compliance

• Monitors and reviews billing processes to ensure accurate coding and compliance with payer requirements.
• Conducts internal compliance audits to detect errors, prevent fraud, and improve the accuracy of claims submissions or other regulatory requirements.
• Collaborates with the operations, billing, and finance teams to implement corrective actions for discrepancies.

Risk Management and Incident Response

• Identifies, assesses, and proactively mitigates compliance risks across Pediatrics Plus.
• Reports and investigates compliance concerns, including anonymous reporting channels.
• Conducts and documents investigations into compliance incidents and, as appropriate, recommends corrective and preventive measures to mitigate risk of recurrence.

Team Member Training and Culture Building

• Develops and delivers ongoing education and training programs for clinical and administrative team members on compliance topics, including regulatory changes, HIPAA, billing, and ethical behavior.
• Fosters a culture of integrity, accountability, and transparency within Pediatrics Plus.
• Ensures all team members understand their responsibilities regarding compliance and the ethical standards of Pediatrics Plus.

Compliance Audits and Assessments

• Designs and implements routine and targeted audits to monitor compliance with internal policies and external regulations.
• Prepares reports on audit findings and presents recommendations for corrective actions.

Performance Reporting and Continuous Improvement:

• Develops metrics to track the effectiveness of compliance initiatives and regularly reports results to senior leadership and stakeholders.
• Stays abreast of industry trends and emerging risks, incorporating them into proactive compliance strategies.
• Leads efforts to continuously improve compliance processes, leveraging technology and best practices for greater efficiency.

General

• Participates in one-on-one meetings with leader.
• May perform other related and non-related duties, as assigned.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

What you have:

• In-depth knowledge of HIPAA regulations, healthcare billing practices, and federal/state healthcare laws.
• Experience conducting audits, risk assessments, and investigations.
• Proven ability to communicate compliance concepts to both clinical and administrative team members.
• Strong business acumen and strategic thinking skills, with the ability to translate vision into actionable plans and initiatives.
• Strategic problem-solving and decision-making abilities, with a focus on driving results and continuous improvement.
• Strong organizational and leadership skills.
• Exceptional attention to detail and analytical skills.
• Excellent interpersonal, verbal, and written communication
• Ability to manage multiple priorities and meet deadlines.
• High level of integrity and commitment to confidentiality.
• Travel may be required.

Education/Experience:

• Bachelor's degree, required.
• 3+ years of experience in healthcare compliance or a related field; experience in pediatrics or clinical healthcare, preferred.
• Certification in healthcare compliance (CHC) or similar credential, preferred.

Physical Demands:

While performing the duties of this job, the team member is frequently required to accurately communicate information and ideas so others will understand through sight and hearing. The team member is regularly required to move including walking, running, jumping, and sitting. The team member is regularly required to use hands and fingers to handle, lift, reach, and feel. The team member is frequently required to stand and stoop, twist, bend, kneel, crouch, or crawl. The team member must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include near and distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. If the team member is working at a Farm location, they must be comfortable around standard farm animals, including minimal allergies to touching, smelling, feeding, and engaging with animals.

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.