Compliance Manager-PHP

Location Address: 9521 San Mateo NE, Albuquerque, NM

Compensation Pay Range: Minimum Offer $77,563.20;
Maximum Offer $

The Compliance Manager performs daily tasks to support the PHP/PIC Compliance Officer with implementation and administration of the PHP Compliance Program. Under the direction of the PHP/PIC Compliance Officer, assists in the monitoring and auditing of PHP practices to ensure ongoing compliance and minimization of risk through the development, review and oversight of policies, procedures, business practices, and guidelines that demonstrate compliance with state and federal laws and regulatory requirements.

This position supports the PHP/PIC Compliance Officer in all health plan compliance activities for all product lines. Major duties include, but are not limited to, assisting the PHP/PIC Compliance officer with implementing the elements of an effective health plan compliance program, and facilitating the successful completion of audits by external government agencies. These agencies include but are not limited to, CMS, HSD, DOI, OPM (FEHBP) and DOL (ERISA).

The Compliance Manager interacts directly with health plan staff, as well as other PHS staff, regulatory agency staff and external auditors. This position assists in the coordination of responses to regulatory bodies and performs regulatory research and analysis. The Manager also assists with the planning, supervision, and coordination of risk assessments, which includes conducting identified internal monitoring and auditing activities as required for management of PHP's Compliance Program.

Type of Opportunity:
Full time. Job Exempt:
Yes. Job is based:
Reverend Hugh Cooper Administrative Center.

Work Shift:

Days (United States of America).

• Assists with ensuring that PHP has written compliance standards and procedures covering all necessary areas to be followed by PHP employees and other agents; establishes and monitors updates, revisions, training, and communication.
• In collaboration with the PHP/PIC Compliance Officer, provides direction and oversight of all compliance program auditing, monitoring and related functions, including Risk Assessments and meeting contractual obligations.
• In collaboration with the PHP/PIC Compliance Officer, consults with operational departments and program/subject matter experts to recommend compliant solutions that support business goals.
• Proactively identifies compliance issues and works collaboratively with the PHP/PIC Compliance Officer and operational areas to mitigate risks.
• Assists with the implementation and management of compliance training.
• Assists with the identification and implementation and conducting monitoring and auditing procedures to determine compliance with PHP standards and procedures.
• Provides support for overseeing the prompt and thorough investigation of alleged violations of standards and procedures.
• Reports potential fraud and noncompliance to the PHP/PIC Compliance Officer and other accountable internal leadership.
• Interacts with operational directors/managers, project managers, senior executives, and line staff regarding compliance and related issues.
• Organizes and coordinates cross-functional teams to address compliance issues that involve multiple departments or entities.
• Responsible for ensuring all work which includes audits (internal/external), monitoring, tracking and issues of non‑compliance are logged timely and accurately in the Governance Risk Compliance Platform (eGRC).
• All other duties as assigned.

• Bachelor's Degree.
• Five to seven years experience in healthcare management or law/regulations.
• Managed care health plan experience in Medicare, Medicaid or Commercial required.
• CHC or willingness to obtain within 1 year.

All benefits‑eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short‑term and long‑term disability, group term life insurance and other optional voluntary benefits.

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