Senior Manager of Compliance

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It’s no wonder 98% of patients report being fully satisfied with Upward Health! 

Job Title & Role Description:

The Senior Manager of Compliance at Upward Health is responsible for overseeing and enhancing our fraud, waste, and abuse (FWA) prevention efforts, managing internal and external audit processes, and responses to patient grievances shared by health plans. This role involves identifying risks, investigating potential violations, and collaborating across departments to develop and implement compliance programs, with a particular focus on FWA, that maintain ethical and legal standards. As the organizational Compliance Officer, the Senior Manager will oversee compliance activities, audits, corrective actions, and continuous improvements. They will serve as subject-matter expert on HIPAA, Medicare/Medicaid program integrity, billing and coding compliance, and in-home service regulations. 

Reporting to the Chief Financial Officer, with a dotted line to the CEO, this role will have broad responsibility to collaborate with legal, finance, clinical leadership, and operations to address emerging risks and ensure aligned practices. 

Key responsibilities include creating, implementing, and maintaining policies and procedures, managing responses to external audits and patient grievances shared by health plans, and conducting internal audits. The Senior Manager will develop corrective action plans for identified issues, prepare reports for senior management and the Compliance Committee, and ensure proper reporting of violations to enforcement agencies. Additionally, the Senior Manager will work with the Compliance Committee and departments to address compliance issues, implement solutions, and establish a system for employees to report fraud or other improprieties without fear of retaliation. 

As the primary person managing Upward Health’s privacy office email inbox, the Senior Manager will manage the receipt, archival, and transmission of patient records to ensure compliant handling of sensitive data and act as the vendor manager for third-party partners involved in information release. They will lead investigations into suspected fraud, waste, and abuse, serve as chairperson of the Compliance Committee, and be the primary contact with legal counsel and external auditors for compliance-related reviews. The Senior Manager will also maintain updated processes, facilitate annual risk assessments, and provide ongoing guidance and training to staff on compliance matters. Other duties may be assigned to support organizational goals. 

Skills Required:

• Strong foundational knowledge of compliance, healthcare laws, and regulations.

• Strong knowledge of Medicare/Medicaid billing rules, HIPAA, and value-based care programs

• Certified in Healthcare Compliance (CHC) or equivalent strongly preferred.

• Excellent analytical, research, and problem-solving skills.

• Strong written and oral communication skills.

• High attention to detail and ability to identify potential compliance issues.

• Ability to independently manage multiple projects and prioritize effectively in a fast-paced environment.

• Ability to work collaboratively with diverse teams and external partners.

• Proficiency in Microsoft Office  

Key Behaviors:

Integrity & Accountability:  

• Actively upholding ethical standards, maintaining confidentiality, and consistently acting with integrity.

Leadership:  

• Leading compliance initiatives, influencing organizational culture, and guiding others in maintaining compliance.

Adaptability:  

• Demonstrating flexibility in a fast-paced, evolving work environment while staying focused on achieving compliance goals.

Effective Communication:  

• Communicating complex compliance issues clearly and effectively, both in writing and verbally, to all stakeholders.

Collaboration & Teamwork:  

• Building strong relationships internally and externally, working with others to resolve compliance issues and improve processes.

Competencies:

Compliance Management:  

• Ability to create, implement, and maintain policies and procedures ensuring legal and regulatory compliance.

Risk Assessment & Audit:  

• Proficiency in assessing compliance risks, conducting internal audits, and developing corrective action plans.

Problem Solving & Decision Making:  

• Strong analytical skills to address compliance-related issues, make decisions, and implement solutions.

Regulatory Knowledge:  

• In-depth understanding of healthcare laws, regulations, and industry standards, with a focus on maintaining up-to-date knowledge.

Vendor Management:  

• Experience managing relationships with vendors, ensuring that third-party actions align with compliance standards.

Training & Development:  

• Ability to educate and train staff on compliance topics, ensuring that all team members understand and follow necessary protocols.

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.