Healthcare Compliance Officer

Key Responsibilities

• Support and run the compliance program using the seven elements: policies, training, monitoring, reporting, enforcement, response, and oversight.
• Monitor compliance with HIPAA Privacy, Security, and Breach Notification Rules.
• Manage privacy incident investigations and breach risk assessments.
• Review billing, coding, and documentation for accuracy under Medicare, Medicaid, and commercial payer rules, including False Claims Act, Anti-Kickback Statute, and Stark Law exposure.
• Conduct internal audits, risk assessments, and focused reviews.
• Track corrective action plans to completion.
• Manage the compliance hotline and reporting channels.
• Investigate concerns fairly and confidentially, with non-retaliation protections.
• Screen employees, providers, and vendors against OIG, SAM, and state exclusion lists.
• Manage credentialing and licensure checks.
• Review vendor and business associate relationships, BAAs, and third-party risk.
• Develop, update, and distribute policies and procedures, ensuring readability and usability.
• Design and deliver compliance training and awareness.
• Prepare for and support external audits and surveys (CMS, OCR, state agencies, RACs, UPICs, Joint Commission, and payers).
• Track regulatory changes, including price transparency, information blocking under the 21st Century Cures Act, and state privacy laws, and translate them into action.
• Support compliance for telehealth, remote patient monitoring, and the responsible use of AI-assisted tools in clinical and administrative work.
• Report program metrics and risks to the Compliance Committee and senior leadership.
• Partner with legal, privacy, security, revenue cycle, clinical, and HR teams.

Levels & Ownership

• Compliance Officer I (0-2 years): Monitoring, audit support, hotline intake, exclusion screening, policy upkeep, and training logistics. Learning with a dedicated mentor and a paid certification plan.
• Compliance Officer II (2-5 years): Owning audits and investigations, running risk assessments, advising departments, leading training, mentoring newer staff.
• Senior Compliance Officer (5+ years): Leading the program or a major domain, managing complex investigations and regulator interactions, advising executives and the board, developing the team.

Requirements & Tech Stack

• Working knowledge of healthcare regulation, or strong related experience in healthcare operations, coding, auditing, law, or clinical work.
• Understanding of HIPAA and the basics of how healthcare is billed and reimbursed.
• Sound judgment, integrity, and discretion with sensitive matters.
• Strong analytical and investigative skills, with attention to detail.
• Clear writing and communication, including explaining rules to non-experts and holding firm when needed.
• Bachelor’s degree in Healthcare Administration, Health Information Management, Business, Law, Nursing, or a related field, or equivalent experience.
• Authorization to work in the US.

Nice to Have

• Certifications: CHC (Certified in Healthcare Compliance), CHPC, CCEP, CHPS, CPC, CCS, CIA, or similar.
• Experience with audit, investigations, or internal controls in a healthcare setting.
• Knowledge of Medicare Advantage, Medicaid managed care, or specific settings (hospitals, physician groups, behavioral health, home health, skilled nursing, or labs).
• Familiarity with GRC platforms (e.g., Compliance 360, MetricStream, Archer, or LogicGate) and privacy tools.
• Experience with the Office of Inspector General’s compliance program guidance.
• Paralegal, JD, nursing, or health information management background.
• Experience in hospitals, health systems, payers, physician groups, behavioral health, post-acute care, health tech, etc.
• Second language, particularly Spanish.