This post provides detailed information on the healthcare compliance manager job description, including the key duties, tasks, and responsibilities they commonly perform.
It also highlights the major requirements that you may be expected to meet to be hired for the healthcare compliance manager role by most recruiters/employers.
What Does a Healthcare Compliance Manager Do?
A healthcare compliance manager is responsible for ensuring that organizations comply with Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Health Insurance Portability and Accountability Act (HIPAA), and accreditation standards by implementing and administering practices, programs, and policies.
His/her job description entails monitoring and administering compliance with local, state, and federal regulators.
He/she is also responsible for coordinating visits by regulators to sites and acting as a liaison to government agencies.
The compliance manager role also involves investigating potential violations and taking appropriate actions to correct them.
He/she is expected to work and report to the unit head and to supervise the day-to-day functions of subordinate staff to ensure top performance.
This position is a first level manager job where he/she has complete authority over staff action and is expected to adhere to approved budgets, and ensure that departmental milestones/goals/projects are met.
He/she must follow all safety procedures and policies in carrying out his/her duties and responsibilities, and must also support a culture of great customer service and high quality in the organization.
Following directions, the compliance manager is responsible for carrying out complex healthcare audits, such as the establishment of objectives, goals, quality measures, and timelines for the team’s activities in a timely manner.
His/her work description also involves conducting reviews of compliance work following established compliance plan(s), appropriate standards, metrics, and prescribed program and departmental policies.
He/she is also responsible for administering and maintaining various compliance technology solutions, including monthly newsletter, Hotline, Risk Assessment software, Audit/Monitoring, Regional Compliance Committee documentation, exclusion/sanction screening, and learning management system.
He/she is also in charge of managing compliance team staff and organizing and maintaining compliance regulatory files and team notebooks.
As directed by Executive Compliance Committee, Regional Compliance Committee, and Compliance Officer/HIPAA Privacy Officer, the manager has the role to prepare compliance reports.
He/she may also be involved in documenting confidential investigations of alleged misconduct, breaches of policy, and other cases of non-compliance.
Healthcare compliance managers are also involved in developing and maintaining compliance-related training and educational materials.
Healthcare Compliance Manager Job Description Example/Sample/Template
Healthcare compliance managers perform various functions in ensuring that organizations comply with established healthcare regulations.
Below is a job description example that shows major healthcare compliance manager tasks, duties, and responsibilities, which you may be assigned if hired for the role:
- Carry out assessment of healthcare compliance policy and procedure and assist in updating or developing new policies to enhance operations or/and internal controls or to consider new areas
- Carry out risk analysis on healthcare compliance, discover areas of potential compliance risk and vulnerability, and create and implement solutions to eliminate the potential risks
- Manage and direct healthcare training and educational programs
- Supervise compliance training in other laws such as the Federal Food, Drug and Cosmetic Act, Physician Payment Sunshine Act, HIPAA, and related state laws to get employees informed on ethical and legal standards
- Leverage familiarity and understanding with the PhRMA Code, OIG-DHHS seven elements of an effective compliance program, and the AdvaMed Code
- Carry out internal monitoring and auditing for policy compliance, discover preventive and corrective measures executed for audit findings made earlier, and coordinate internal and external corrective measures to be executed
- Assist in bid preparation for government, including performing reviews of quotes and submission
- Be informed of current legislation and enforcement issues affecting the healthcare industry, as well as compliance best practices
- Work closely with others in related departments, including legal, HR, IT, Regulatory, and Finance for effective investigation, resolution, reporting, and remediation of compliance issues
- Prepare report for management on incidents, investigations, and all compliance issues
- Carry out due diligence on new healthcare businesses before they are acquired and design effective integration plan
- Assist HIPAA Privacy Officer in carrying out their responsibilities
- A pre-employment assessment test may be required before you can be hired for this job.
Requirements – Knowledge, Skills, and Abilities – for Healthcare Compliance Manager Role
If you are seeking the job of a healthcare compliance manager, the following are important requirements and qualifications most employers may want you to have to stand the chance of being invited to an interview:
- Possess a minimum of five years experience in the healthcare compliance industry
- Possess Juris Doctor (J.D.) degree from an approved law school, with admittance to at least one state bar in good standing
- Experience and ability to initiate, develop, maintain, and review policies and procedures for the operation of a healthcare compliance program and other similar activities to prevent unethical, illegal, or improper conduct
- Healthcare compliance evaluation and auditing experience to be able to discover operational problems and recommend and execute strategies to provide needed solution
- Strong ability to prioritize and perform multiple projects concurrently
- Strong communication skills to effectively report project risks and progress to senior management and colleague
- Strong knowledge of Excel, PowerPoint, and SAP
- Proven ability to collaborate and advice management on compliance matters; ability to develop practical business solutions and to facilitate risk assessment
- Possess relevant certification in healthcare compliance, such as or CCEP, CHC, CHC-F, or CHRC, or a Certified Fraud Examiner (CFE) certification, or successful completion of a graduate certification program in healthcare compliance.
This post provides exhaustive detail of what healthcare compliance managers do. If you are an employer in the process of hiring for the position, you can adopt the sample job description provided in this article in making a comprehensive description of the role in your organization.
By writing and publishing a detailed description of the job, you will be increasing your chances of attracting the best candidates to your offer.
Individuals who are interested in the healthcare compliance career will also find this post useful in learning all they need to know about the job of a healthcare compliance manager and so will be better informed about the career.