Do you want to work for a company that has been recognized by the Denver Post for nearly a decade as a Top Place to Work? Then Physician Health Partners may be the company for you! PHP offers a robust benefit package where the company pays for a majority of medical premiums, vision insurance, dental insurance, 2-week paid FMLA, 401(k) matching, in addition to some perks like happy hours, remote work options and profit sharing! We have two locations in Downtown Denver and Colorado Springs but serve members throughout the state Colorado. If you are interested in working for an innovative and collaborative workplace in the healthcare market than PHP may be the career home for you.

This is a hybrid role working 40 hours a week Monday - Friday with occasional out of state travel

Position Summary: The Program Manager, Healthcare Compliance is responsible for the day to day operations of the Regional Compliance Program and serves as the focal point for all compliance activities. Serves as the Privacy Officer and American’s with Disabilities Act coordinator. Under the direct supervision of the Chief Compliance Officer, the Program Manager will coordinate and communicate all compliance and privacy related activities and programs for the region. The Program Manager, Healthcare Compliance designs and oversees the Compliance Program and Plan which includes: conducting risk assessments; educating the Board of Directors, leadership and employees of responsibilities and risks; documenting processes and findings; overseeing the corrective action process; and trending, tracking and analyzing risk. As the Privacy Officer, the Program Manager will oversee the privacy program, provide education on state and federal privacy laws, investigate incidents in which a breach of PHI may have occurred and report breaches as necessary.

• Assists management in coordinating internal compliance review and monitoring activities including annual or periodic reviews of departments. Assures appropriate risk assessments are completed, annually, and as necessary to identify areas of greatest risk.
• Oversight of the regional Compliance Plan. Works in collaboration the Chief Compliance Officer to ensure the Compliance Plan is in alignment with broader goals.

• Understands that the customer varies depending on the circumstances. The customer could be a medical practice, employee, or external regulator.
• Collaborates with other regional Healthcare Compliance Program Manager(s)
• Maintains positive relations with Health Plans and regulatory personnel.

• Liaises internally across departments and lines of business and externally with community partners to mitigate risks associated with member/patient care.
• Provides guidance to employees/customers on questions concerning use and disclosure of protected health information, coding and billing, and FWA.
• Identifies and evaluates exposures to risk including developing, communicating, and executing initiatives to promote awareness and understanding of compliance issues, applicable laws and regulations, requirements and consequence on non-compliance.
• Collaborates with Human Resources to ensure the enforcement of Compliance Program standards through appropriate disciplinary mechanisms.

• Develops and implements the Compliance Program, including the development of policies and procedures for implementation and operation of the Compliance Program. Periodically revises the program in light of changes in the organizations needs and in the law, and policies and procedures of government and private payer health plans.
• Coordinating personnel issues with the human resources department to ensure that employees do not appear in the List of Excluded Individuals/Entities and the General Services Administration (GSA) list of debarred contractors.
• Develops policies and programs that encourage managers and employees to report suspected fraud and other improprieties without fear of retaliation.
• Creates, maintains, and revises privacy policies, procedures, forms, notices, and associated materials.

• Independently investigates and act on matters related to compliance, including the flexibility to design and coordinate internal investigations and any resulting corrective action with all departments, contracted vendors, and if appropriate, independent contractors. Ensures that any report of non-compliance is investigated and develops and implements corrective action plans for identified areas of non-compliance, in collaboration with appropriate management, and that compliance is achieved and maintained.
• Investigates and resolves complaints or reports about potential HIPAA violations

• Stays abreast of Health Plan requirements and Federal/State laws and regulations that might affect compliance policies and procedures.
• Develops and disseminates policies and compliance standards to ensure compliance with law and regulatory requirements. Leads and supports activities to monitor adherence to policies, procedures and legal requirements.
• Develops, coordinates and participates in a multifaceted educational and training program that focuses on the elements of the Compliance Program and seeks to ensure that all appropriate employees and management are knowledgeable about and comply with, pertinent Federal and State standards. Ensures employees have received, read and understood the standards of conduct.
• Provides consultations, training and guidance to the organization on healthcare compliance (such as coding and billing, FWA, HIPAA, 42 CFR Part 2, mandatory reporting, ADA), privacy, member/patient care, medical record and care management documentation, ethics and conflict of interest. Utilizes real world examples to translate regulations into applicable clinical scenarios.

Qualifications (Education/Experience/Knowledge/Skills):

• Bachelor’s degree in health, business administration or related field required. Master’s degree in related field or BSN preferred.
• Certification in healthcare compliance and/or medical coding preferred.
• Minimum 4-7 years of experience working within a broad variety of healthcare settings.
• Previous HIPAA/Privacy Officer or Compliance Officer experience in a healthcare setting preferred.
• Knowledge of the regulatory environment of health care/Medicare, ethics, and pertinent legislation.
• Knowledge and experience in establishing and/or developing productive relationships with physicians, administrators and other health care industry leaders.
• Knowledge of Microsoft Word, Excel and Outlook
• Act as the role model for ethical behavior in the organization.
• Ability to advise team members at all levels of the organization on Compliance matters in a way that creates understanding and resolution.
• Excellent analytical, problem solving, teambuilding and customer services skills with the ability to work collaboratively at all levels within the organization.
• Skilled in developing and maintaining positive relationships and in communicating effectively with internal and external clients through written and verbal communication.
• Skilled in managing projects and deadlines.
• Skilled in trouble-shooting, problem solving, and documenting resolution.
• Ability to interpret legal opinions and make recommendations based on laws.
• Ability to generate and encourage creative ideas, innovative thinking and imaginative solutions to issues or problems related to compliance.
• Ability to interact with all members of the organization in ways that enhance understanding, respect, cooperation and problem solving.

Employees will be required to show proof of being fully vaccinated to COVID-19 within 30 days of hire. Reasonable accommodations may be considered on a case-by-case basis for certain exemptions in accordance with applicable law. Applicants should be aware, though, that for external-facing roles, particularly those involving close contact with vulnerable individuals, accommodations that involve not being vaccinated against COVID-19 may not be deemed reasonable. The Company will engage in the interactive process on an individualized basis in light of each particular role.