Healthcare Compliance Manager

About the role

Responsibilities

• 1. CMS / Medicare RPM Billing Compliance • Own the monthly billing compliance review cycle — validate CPT code selection (99453–99470), data-day thresholds, and mutual exclusivity rules before claims are released. • Monitor CMS Final Rules, MAC Local Coverage Determinations (LCDs), and OIG Work Plan items affecting RPM billing; brief leadership on material changes within 30 days. • Maintain the pre-bill dual-attestation workflow and enforce the 99458 MUE cap and time-counting rules. 2. HIPAA Privacy & Security Program • Serve as Dozee's designated HIPAA Compliance Officer — conduct annual Security Risk Assessments, manage the Notice of Privacy Practices, and oversee BAA lifecycle for all vendors and SNF partners. • Lead breach investigation and notification workflows; coordinate with Melvin Law Group on any reportable incident. 3. SOP Development & Version Control • Own and maintain the full CAIT/Dozee SOP library (currently seven SOPs, v2.1) — initiate updates within 30 days of any material regulatory change. • Manage the annual SOP review cycle; obtain CEO and VP sign-off; track version history and change logs. 4 .Internal Audit — Monthly Claims Sampling • Conduct monthly random-sample claims audits (minimum 10% of submitted claims) — verify documentation completeness, code accuracy, and consent/care-plan compliance. • Track audit findings in the Compliance Tracking Log; escalate repeat findings to VP Administration; implement and verify corrective actions within agreed timelines. 5. Staff Training & Annual Attestation • Design, deliver, and track annual compliance training for all clinical, billing, and administrative staff — covering CMS billing rules, HIPAA, AKS, and the OIG RPM Compliance Framework. • Maintain training attestation records in Circle Health Domain 0.2; generate compliance attestation reports for VP and CEO annually. 6. Overpayment Management — 60-Day Rule Enforcement • Maintain the Overpayment Tracking Log; ensure all identified overpayments are investigated, classified (isolated vs. systemic), and refunded within the 60-day statutory deadline. • Coordinate with the Billing Manager on MAC refund submissions; consult Melvin Law Group on any systemic overpayment before refund. 7. Regulatory Intelligence & State Monitoring • Monitor applicable state NP practice act changes across CAIT's six operating states (TX, OH, PA, FL, NY, MO) and Dozee's expansion targets. • Track RHTP, THRIVE, and NIH grant compliance obligations as Dozee enters new government programs. 8. Contract & AKS Compliance Support • Review all SNF partner and vendor agreements against the Anti-Kickback Statute checklist before execution; escalate any FMV or referral-contingency concerns to VP Administration and Melvin Law Group. • Maintain executed contract files and the annual contract review schedule.

Requirements

• Experience : Minimum 5 years in healthcare compliance — Medicare billing, HIPAA, or post-acute / RPM environment strongly preferred. Certifications: Certified in Healthcare Compliance (CHC) required or obtainable within 12 months of hire. CHPC (privacy) a plus. Technical : Working knowledge of CPT coding (99453–99470), CMS PFS Final Rules, OIG Work Plan, MAC audit processes, and AKS/Stark safe harbors. Skills : Strong SOP writing, audit documentation, and cross-functional communication skills. Ability to deliver training to clinical and non-clinical staff. Systems : Familiarity with healthcare compliance platforms (preferred); proficiency in Microsoft 365 required. Education : Bachelor's degree required; healthcare administration, law, or clinical field preferred.