Compliance Program Manager

We are currently seeking a Compliance Program Manager to join our team of highly qualified professionals that share our mission of Empowering Children to Conquer their World! Pediatrics Plus is a highly collaborative pediatric healthcare provider. We are committed to helping children succeed in all stages of life through evidence-based therapy (Applied Behavior Analysis, Occupational Therapy, Physical Therapy, and Speech Therapy) and developmental preschool services, state of the art facilities, specialized equipment, family support and education, and community investment.

What we offer:

• Competitive Pay
• 15 Days of Paid Time Off
• Company Discounts & Incentives
• Professional Development and Leadership Growth Opportunities
• State of the Art Facilities & Technology

What you will do:

The Compliance Program Lead will be instrumental in planning, implementing, maintaining, and administering a system-wide compliance program for Pediatrics Plus, ensuring adherence to healthcare regulations, including HIPAA, billing codes, and internal policies. They will proactively monitor potential compliance risks, develop and implement preventative measures, and foster a culture of compliance to protect the practice, its clients, and stakeholders. The Compliance Program Lead will empower teams to prioritize compliance as a business enabler, promote ethical behavior at all levels, and ensure seamless integration of compliance practices into day-to-day operations.

The Compliance Program Lead will also provide strategic guidance to ensure compliance practices align with the growth goals of Pediatrics Plus while mitigating risk.

Regulatory Compliance and Governance

• Ensures adherence to all healthcare regulations, including HIPAA, HITECH Act, OSHA, Stark Law, and federal/state requirements for pediatric practices.
• Under the guidance and direction of the Chief Legal Officer and Compliance Committee, the Compliance Program Lead will develop and implement strategies to ensure ongoing compliance with evolving healthcare laws and regulations.
• Coordinates internal and external compliance audits and inspections and as designated by the Chief Legal Officer, serves as a point of contact with regulatory agencies.

Compliance Program Administration

• Under the direction of the Chief Legal Officer and Compliance Committee, develops, maintains, monitors, and continuously improves a comprehensive compliance framework, including policies, procedures, and standards aligned with healthcare regulations and best practices.
• Establishes governance structures to ensure compliance initiatives are effectively monitored and reported.
• Conducts regular evaluations of compliance programs to identify areas for improvement.
• Assists the Chief Legal Officer in developing the annual Compliance Work Plan and is responsible for coordinating and tracking implementation of approved work plan activities.

HIPAA and Data Privacy Oversight

• Develops policies to safeguard Protected Health Information (PHI) and ensure full compliance with HIPAA and other privacy regulations.
• Leads investigations into data breaches or privacy violations and implements corrective actions.
• Conducts regular team member training on privacy practices, data security, and the importance of protecting patient information.

Billing, Coding, and Documentation Compliance

• Monitors and reviews billing processes to ensure accurate coding and compliance with payer requirements.
• Conducts internal compliance audits to detect errors, prevent fraud, and improve the accuracy of claims submissions or other regulatory requirements.
• Collaborates with the operations, billing, and finance teams to implement corrective actions for discrepancies.

Risk Management and Incident Response

• Identifies, assesses, and proactively…