Compliance Program Manager, Provider Operations - Jefferson Health Plan

Number of Positions In Requisition

1

Job Details

The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans.
The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency.

Job Description

Summary
The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency.

Job Duties

• Ensure Regulatory Compliance: Track and maintain all compliance activities across all lines of business and work with units within the department to complete. Compliance activities include but are not limited to: External day-to-day inquiries, Internal/ External Audit Deliverables, Regulatory reporting
• Review department policies, procedures and desktop procedures to ensure they meet regulatory requirements.
• Conduct Monitoring, Auditing and Improvement Action Plan Activities within internal Teams: Conduct monitoring for all lines of business (Medicare, Medicaid, CHIP and ACA) according to departmental processes and workflows.
• Perform scheduled audits according to Compliance Work Plan
• Perform ad-hoc targeted regulatory audits as needed.
• Oversee the development, implementation and management of departmental improvement action plans initiated by internal and/or external audits by conducting root cause analysis, track progress, educate on audit errors and ensure timely completion of corrective measures.
• Audit & Meeting Management: Provide leadership in audits and reviews by regulatory bodies. Ensure accurate data collection and timely submission. Compile audit findings and report to executive management and internal committees as needed.
• Prepare assigned teams for internal and/or external regulatory audits by reviewing previous audit material and results and ensuring that department is ready and available to meet the needs of active and upcoming audits.
• Serve as the Compliance liaison for facilitating monthly Compliance team’s meetings.
• Risk Mitigation: Research trends and identify areas that present potential risk to the departments.
• Utilize identified potential risks related to non-compliance to develop internal department improvement action plans to address deficiencies.
• Support Organizational Strategy: Assist in developing, producing, and conducting compliance training programs for staff to understand regulatory requirements.
• Improve Efficiency: Enhance operational efficiency by standardizing regulatory workflows.
• Support and deliver regulatory reporting and performance initiatives.

Minimum Qualifications

• Bachelor’s Degree in a relevant field such as: Business Administration, Healthcare Administration, Public Health, Compliance, Risk Management, or a related field
• 5 years of experience in: Compliance, auditing, or risk management, Healthcare operations or a highly regulated industry, Managing or coordinating internal/external audits or Developing or overseeing compliance monitoring activities
• Strong analytical and critical thinking skills to assess compliance risks and identify solutions.
• Excellent written and verbal communication skills for clear reporting, training, and collaboration.
• Project and program management skills to organize, prioritize, and track multiple compliance initiatives.
• Audit and monitoring skills, including data collection, analysis, and reporting.
• Ability to develop, conduct, and deliver effective compliance training programs.
• Conflict resolution and negotiation skills.
• Attention to detail and accuracy in documentation and reporting.
• Strong interpersonal skills and ability to build relationships across departments and with external regulators.
• Ability to interpret and apply complex regulations and policies to business operations.
• Capacity to work independently and as part of a team in a fast-paced environment.
• Ability to lead cross-functional teams and manage multiple stakeholders.
• Skill in identifying compliance gaps and driving corrective action.
• Adaptability to changing regulatory environments and business needs.
• Strong organizational skills and time management.
• Ability to maintain confidentiality and handle sensitive information ethically.
• Facilitation and presentation skills to engage and educate staff.

Additional Qualifications

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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