Compliance Manager, Payer Services

The Legal team at Integra Partners, a Dragonfly Health company, works cross-functionally to help achieve our mission of reducing friction in healthcare. We are committed to working collaboratively, transparently, and efficiently to provide exceptional legal and compliance services to our internal stakeholders, health plans, and providers. We are committed to excellence in our work, a growth mindset and continuous improvement, and cultivating a deep understanding of the healthcare industry.
We are hiring a Compliance Manager to be an integral member of the Legal team and ensure we meet and exceed all our compliance obligations. In this role, you will bring your previous compliance experience and knowledge to drive compliance strategy and identify risks. Some of your key responsibilities will be administering our compliance program and assisting with the integration of general compliance processes, overseeing Managed Care audits and managing the compliance relationships with our customers as well as keeping up-to- date and managing compliance changes that impact our business and the DMEPOS industry. You will work closely with our General Counsel, Payer Services and partner with individuals at all levels of the company. This role will manage a compliance analyst, who will conduct FWA investigations of our network and risk reviews. You will also support the privacy program. If you are a self-starter, service-oriented, and able to interpret and communicate complex information, then this is an excellent opportunity as a next step in your career.
JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES

The Compliance Manager’s responsibilities include but are not limited to:

• Administer the company’s Corporate Compliance program, including creating and documenting initiatives through managing regular meetings with teams, ensuring projects are on task and goals are met, and reporting on progress to leadership
• Develop, assign and monitor compliance training and keep detailed, auditable records
• Own Fraud, Waste, and Abuse investigation processes, reporting out to senior leaders and customers
• Lead calls with Payers and DME providers on issues of interest
• Research and advise on compliance issues that impact our business
• Collaborate with our credentialing, quality assurance, and network management teams to address any concerns and implement change as needed
• Manage the compliance training program
• Develop compliance programs and initiatives for employees
• Conduct audits of vendors and healthcare providers
• Partner with health plans on audits of our business
• Investigate compliance concerns and issues internally and externally
• Ensure we are up to date with licensing and other filings with state agencies
• Audit current legal, compliance, and related policies, to comply with current contractual, legal, and regulatory obligations; implement change as needed.
• Conduct Security Risk Assessments and present results to the compliance committee.
• Work closely with our data security staff to address security issues that arise
• Manage license renewals
   

Your first 30 days

• Within the first month, you will learn about Integra’s business, our policies and procedures, learn how Medicare and Medicaid guidelines impact our business, how we run our compliance programs, and be introduced to the teams with which you will partner cross-functionally. Your first 60 days
• Within your first 90 days working with the company, you will take ownership of our employee compliance training program, and complete in depth review of the Payer Services business.

Your first 6 months

• We expect that within six months you will have a strong grasp of the rules and regulations which govern our business and be the first point of contact for all compliance needs. You will take ownership of audits and partner with teams on any compliance or security concerns. We expect that you’ll also be able to recommend ways in which we can improve our processes, procedures, and making sure we’re up to date with regulatory changes impacting the business.

EDUCATION: Bachelor’s degree. JD preferred.

EXPERIENCE:

• At least six years’ experience in corporate compliance or similar roles; previous healthcare experience is preferred.
• Strong understanding of revenue cycle management, fraud waste and abuse issues, healthcare credentialing, CMS guidelines, medical billing, HIPAA, HITECH, and related legislation
• Strong analytics background, particularly claims data analysis
• Strong attention to detail
• Excellent written and verbal communication skills
• Demonstrate strategic thinking to implement continuous improvement efforts for our compliance program
• Experience drafting and reviewing policies and procedures
• Excellent organizational skills, ability to manage multiple projects at once, follow through, and meet tight deadlines.
• A commitment to provide high quality client service and a strong desire to build trusted advisor relationships with key clients and executives.
• Ability to manage and handle sensitive and confidential information with the highest levels of integrity, ethical standards, discretion, and sound judgment.
• Team player able to collaborate across various teams and levels and form strong working relationships.
• Ability to deliver results in a fast moving, and fast changing, environment.