Healthcare Compliance Manager

Position Summary:

The Compliance Manager is responsible for building, executing, and continuously improving Dozee's healthcare compliance program across all regulatory domains — Medicare RPM billing, HIPAA privacy and security, FDA device compliance, and Anti-Kickback Statute adherence. The role reports to the VP Administration and is the organization's primary day-to-day compliance operator, translating policy into procedure and ensuring every business function performs within established legal and regulatory boundaries.

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.