ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. We partner with health plans and their neonatal providers to work collaboratively in developing a plan of care specific to the needs of each child - from admission to the intensive care nursery until they are safely transitioned from the hospital, through the first year of life. Our program promotes appropriate utilization, improves access, educates family members, reduces costs, and improves outcomes.

Job Role

The Manager of Compliance & Privacy is responsible for the execution and implementation of the Corporate Compliance Program. This role implements and monitors against ProgenyHealth’s policies and procedures to ensure compliance with all applicable federal, state, and local laws, regulations, including Medicaid requirements, Anti-Kickback and HIPAA. The Manager tracks laws and regulations that might affect the organization’s policies and procedures and works with other associates to design policies and training as appropriate. The Manager investigates reports of alleged violations of ProgenyHealth’s policies and HIPAA incidents, monitors and manages compliance related complaints via the e-mail hotline, and works with Legal, HR and senior leadership as appropriate. The Manager prepares compliance reports to present to senior leadership. The Manager will report to the General Counsel and Chief Compliance & Privacy Officer.

• Coordinate routine risk assessment, develop action plan to address issues identified, institute program for on-going monitoring, and schedule 3rd party Compliance Program audits and remediate identified issues.
  
• Assist with annual review of organization policies and procedures, updating Code of Conduct and Standards of Conduct along with other associates, including Human Resources.
  
• Provide continuous monitoring of Compliance Program, periodic reports and updates to the Compliance Committee and senior leadership; and report significant matters to the Chief Compliance Officer as necessary.
  
• Ensure that all associates and independent contractors doing business with or for ProgenyHealth are run through OIG, GSA, and other Excluded Parties Systems, and that any excluded individuals are identified.
  
• Implement and manage the corrective action process (CAP), including drafting and monitoring CAPs, making recommendation for most appropriate solutions and corrective actions, and providing updates to leadership.
  
• Work closely with Sales, Implementation, and Operations to manage contract compliance starting at on-boarding/implementation phases and provide continuous monitoring to ensure end to end contract compliance.
  
• Review business processes, systems, work-flows, SOPs, policies and procedures to identify, document, and elevate the risks and trends, that may be non-compliant with contracts and/or statutory requirements.
  
• Maintain central content repository for client and vendor contracts and Policies & Procedures for compliance.
  
• Conduct research on compliance topics, including but not limited to privacy, federal regulations, and state laws, including review of OIG work plan and related publications for known risk areas. 

Qualifications

• Bachelor’s Degree in Business Administration, Finance, Accounting, Healthcare Compliance or related field
• Minimum 3 + years’ experience progressive compliance experience required in health care compliance, managed care, government contracts, or related regulatory field.
• Certified in Healthcare Compliance (CHC) and/or Privacy is preferred; required to obtain when meeting the requirements for certification.
• Experience in auditing against contract requirements and deliverables.
• Experience in project management, business process analysis, work flow, and task analysis.
• Understanding of compliance concepts and practices, strategies, control activities, information analysis and reporting is required.
• Experience with drafting Policy and Procedures and oversight. Ability to read and understand contracts, regulations and policies is a must.
• Prior experience in state, federal regulatory oversight is preferred.
• Must be able to effectively work in a fast-paced environment with changing priorities, deadlines and workloads.
• Must be able to meet established deadlines and handle multiple customer service requests from internal and external customers, within set expectations for service excellence.
• Successful candidate will possess strong organization, coordination and interpersonal skills for facilitating Compliance audits.

Benefits/Culture

Our team is our most important asset. some of the benefits we offer our team are:

• 401K with company match
• Medical and dental benefits
• Long Term Disability
• Paid Time Off
• Business Casual Work environment
• Team orientated events throughout the year