Compliance Manager, Audit (Remote)

Role Scope:

The Habitat Health Compliance Manager has oversight for ensuring the successful outcome of the organization’s Centers for Medicaid & Medicare Services (CMS) and State Administering Agency (SAA) audits, and for partnering with leadership to foster a culture of compliance. The Manager reports directly to the VP of Compliance and serves a key role in ensuring effective audit preparation and CMS and SAA audit results.

• Audit readiness activities for CMS and SAA audits, including internal monitoring of audit universe data (e.g., medical records), training, review of applicable company policies/procedures, and corresponding processes;
• Live audit management, including serving as point person with the CMS and SAA audit teams, submission quality assurance, and corrective action plan development, approval, and monitoring;
• Expertise on PACE audit data, trends, best practices, and risk mitigation, and responses to audit-related questions and business development components;
• Regular and consistent internal audit-related reporting and metrics for the Chief Medical Officer, the Executive Compliance Committee, and compliance subcommittee of the Board of Managers;
• Makes recommendations for updates to the Compliance Department’s annual auditing and monitoring workplan and recommendations to the business on needed areas of focus based on audit findings and PACE regulatory trends;
• Builds and fosters collaborations with the Habitat Population Health and Practice Operations teams regarding audit-related impacts to the Quality Improvement Program and center operations;
• Performs other Compliance Department duties, as needed.

As a member of the Compliance Department, the Audit Manager is also expected to represent the compliance program within the Habitat Health team, including:

• Developing and maintaining productive relationships with all levels of staff; and championing the compliance program.

Some travel will be required, including but not limited to, travel in anticipation and support of regulatory audits.

Required Qualifications:

• Minimum of three (3) years of experience in healthcare audit or related field;
• Active and unrestricted Registered Nurse (RN) License;
• Experience in PACE compliance highly preferred;
• Aligns with our purpose and our values, and is excited about living those out in daily practice;
• Ability to lead with influence;
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position;
• Ability to work in a fast-paced environment and in an efficient manner;
• Optimistic and can-do approach;
• Excellent organizational skills and attention to detail;
• Ability to review and interpret data and make data-based recommendations;
• Excellent interpersonal, verbal, and written communication skills;
• Manage multiple projects and identify opportunities for internal and external collaboration;
• Knowledge of the Microsoft 365 suite.

Nice to Haves:

• Bachelor’s degree in healthcare administration, public health, healthcare operations, public policy, or a clinical field;
• Certified in Healthcare Compliance (CHC);
• Experience with DHCS and/or CMS;
• Working knowledge of Epic;
• Experience developing or delivering training (compliance) to adult learners.