Healthcare Compliance Manager

Position Overview This position provides direct support to the Chief Impact Officer by providing all administrative and technical assistance to implement, manage and oversee the Medicaid reimbursement, HIPAA and other contractual obligations necessary to maintain compliance. The role serves as a liaison to the Roadrunner Food Bank Finance Team and acts as an front-end contact for team members who are being billed for reimbursements. Essential Duties and Responsibilities Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions. Design, implement, monitor, audit, and evaluate systems that ensure regulatory compliance and continuous performance improvement. Serve as a liaison with internal and external stakeholders (e.g., regulatory agencies, auditors, community partners) to represent organizational quality and compliance efforts. Oversee internal auditing activities to ensure adherence to quality standards, regulatory requirements, and organizational policies in collaboration with the Finance Team. Participate in local, state, and federal audits, ensuring timely preparation, response, and follow-up with the Finance Team. Oversee the incident reporting process and, in collaboration with the Chief, conduct investigations and recommend corrective actions. Collaborate with organizational leadership to develop, implement, and monitor department‑specific quality improvement, compliance, and risk management plans. Stay up to date on local, state, and federal healthcare regulations, accreditation standards, and payer requirements, and interpret their impact on organizational policies and practices. Lead organization‑wide quality improvement initiatives by identifying trends, gaps, and opportunities for improvement; set measurable goals and track progress toward outcomes. Develop dashboards and reports to monitor compliance and quality metrics; present findings to leadership and committees to drive evidence‑based decisions. Develop and deliver organizational HIPAA training and ongoing compliance education for team members and, as appropriate, partner organizations. Mentor team members on best practices in compliance and quality management. Serve as a technical resource to team members for needed reporting, data collection, and quality metrics. Prepare quarterly reports to inform leadership on the status of activities pertaining to overall compliance for areas of responsibility. Translate Finance to Healthcare/Tech and back internally. Provide technical oversight of PearSuite and Closed Loop Referral System(s). Maintain compliance with insurance requirements and provide Health Plans or Payors with evidence of insurance. Participate in Health Plans’ and Payors’ Utilization and Quality Management and annual HEDIS audits. Maintain infrastructure to mitigate fraud, waste, and abuse. Respond to members’ complaints and grievances with the Health Plans and Payors. Manage arbitration proceedings with legal counsel as necessary. Manage compliance with neglect, abuse, and exploitation policies. Ensure rendering providers maintain credentialing, licensure, CEU, insurance, and periodic required training with the Health Plans or Payors, coordinating with People & Culture Team. Organize periodic HIPAA training for employees and ensure compliance with HIPAA and HITECH federal and state laws in coordination with the People & Culture Team. Manage Corrective Action Plans as required or initiated by Health Plans and Payors, in coordination with the People & Culture Team and supervisors. Submit reports and encounter data to the Health Plans or Payors in a timely manner. Support transfer of members to other Health Plans or Payors. Manage prior authorizations for Community Health Worker services, if needed. Provide Health Plans or Payors with Provider information within 5 days for Provider Directory maintenance. Notify Health Plans or Payors within 7 days of any provider suspension, revocation, or restriction of licensure. Oversee returning and destroying of confidential information within 30 days of termination of agreement with any Health Plan or Payor. Notify Health Plans or Payors of intent by a member to file a claim or commence action within no more than 10 days. Manage medical records in compliance with federal and state laws, regulatory bodies, and MCO requirements. Respond to member or Health Plans and Payors medical records requests within 2–10 business days of requests. Provide medical records to Health Plans or Payors, HCA, CMS, OSI, and other regulatory bodies. Request claim filing extensions beyond 90 days. Respond to Health Plans’ or Payors’ amendments to contracts, provider manuals, or fee schedules within 30 days of notice. Ensure compliance with periodic audits (at times monthly) to guarantee providers meet federal and state laws; review the HHS Office of Inspector General List of Excluded Individuals and Entities. Keep up to date on the Medicare Improvements for Patients and Providers Act (MIPPA). Foster relationship with the internal Finance team to ensure communication and alignment on compliance activities, roles, and responsibilities. Assist Chief in developing and presenting training to staff on compliance processes and procedures. Stay up to date on all current compliance regulations, specifically those regarding Medicaid reimbursement, current healthcare partner contracts, and HIPAA. Translate technical information to accessible, usable policies and procedures. Participate in high‑level/technical components of Closed Loop Referral System(s) by participating in the New Mexico Social Determinants of Health Workgroup. Maintain excellent customer service relations with all internal and external customers. Demonstrate a commitment to the mission of Roadrunner Food Bank and its internal “Culture of Possibilities.” Perform all other job‑related duties as assigned. Exhibit strong leadership, strategic thinking, and decision‑making capabilities. Show strong analytical and problem‑solving skills. Demonstrate the ability to think creatively, proactively, and independently. Prepare reports and presentations, and manage data. Be self‑motivated and results‑oriented. Display strong organizational skills and the ability to meet delivery targets. Maintain discipline and effectively track, document, and report on projects and activities. Collaborate across functional teams and among diverse people and groups. Possess strong oral and written communication skills; interact professionally with the public. Exhibit strategic planning, organizational, and negotiating skills; have comprehensive customer service management experience. Possess computer literacy and data entry skills. Have extensive knowledge of relevant regulatory frameworks and industry standards. Be highly organized with superior attention to detail and excellent follow‑up skills. Maintain a positive attitude and ability to work as part of a team. This is an in‑person position with limited ability to function as hybrid or remote. Work is performed primarily in an office environment using standard office equipment. Requires extensive computer operation with repetitive finger movement. Noise level is typically moderate. Physical Demands Prolonged periods sitting at a desk and working on a computer. Must be able to remain in a stationary position for extended periods, often 50% or more of the workday. Frequently operate a computer and other office machinery; use hands to finger, handle, or feel objects and controls. Use fingers to grasp, move, or assemble small objects. Communicate verbally and understand others, both in person and by phone. Move about the office to access files, machinery, and other areas. Occasionally lift and carry items such as boxes of paper, files, or supplies, typically up to 10–25 pounds. Reach with hands and arms, placing items above, at, or below shoulder height. May need to stoop, kneel, or crouch to file or retrieve items. Push or pull objects like file drawers frequently. See details of objects at a close range and, less importantly, at a distance. Ascend/descend stairs or move between work locations. Operate documents or office equipment requiring reaching above and/or below shoulder. Sit and/or stand for short or extended periods of time. Speak clearly and hear adequately to communicate effectively in person and/or on the telephone. See details sufficient to read source materials and computer screen data. Perform repetitive motions for computer equipment use. Travel Required Infrequent travel required (less than 25% of working time). In‑state travel only, primarily confined to the Albuquerque, NM and Las Cruces, NM metro areas. Overnight stays are rare. Company vehicle provided for travel. Mileage reimbursement is provided for the use of a personal vehicle for work‑related activities. Valid state driver’s license and continuous positive MVRs (Motor Vehicle Reports) are required to drive company vehicles. Required Education, Licenses, Certifications, and Experience Bachelor’s Degree (preferably in public health, nutrition, social work, or related field), or equivalent work experience. 5 years of experience in compliance, risk management, and/or auditing, or equivalent combination of relevant education and experience. At least 3 years of management/leadership experience. Experience developing and implementing compliance programs and controls. Preferred Education, Licenses, Certifications, and Experience Previous experience in a health plan or government programs setting (Medicaid, Medicare, Marketplace). Certificate in Healthcare Compliance (CHC), or other compliance‑related certification. Experience in hunger relief, food access, community building or advocacy, or community health. Work Authorization/Security Clearance Requirements Legally Authorized to work within the United States. Affirmative Action/EEO Statement Roadrunner Food Bank is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or veteran status. E‑Verify Statement Roadrunner Food Bank participates in the E‑Verify program. Other Duties Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice. This position description in no way states or implies that these are the only duties to be performed by the employee in this position. Employees will be required to follow any other job‑related instructions and to perform any other job‑related duties requested by any person authorized to give assignments. This role description excludes the marginal functions of the position that are incidental to the performance of fundamental job duties. All key result areas are essential job functions and requirements. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship. #J-18808-Ljbffr Roadrunner-Food-Bank-of-New-Mexic