Compliance Manager

The Compliance Manager is responsible for building, executing, and continuously improving Dozee's healthcare compliance program across all regulatory domains — Medicare RPM billing, HIPAA privacy and security, FDA device compliance, and Anti-Kickback Statute adherence. The role reports to the VP Administration and is the organization's primary day-to-day compliance operator, translating policy into procedure and ensuring every business function performs within established legal and regulatory boundaries. Responsibilities 1. CMS / Medicare RPM Billing Compliance Own the monthly billing compliance review cycle — validate CPT code selection (99453–99470), data-day thresholds, and mutual exclusivity rules before claims are released. Monitor CMS Final Rules, MAC Local Coverage Determinations (LCDs), and OIG Work Plan items affecting RPM billing; brief leadership on material changes within 30 days. Maintain the pre-bill dual-attestation workflow and enforce the 99458 MUE cap and time-counting rules. 2. HIPAA Privacy & Security Program Serve as Dozee's designated HIPAA Compliance Officer — conduct annual Security Risk Assessments, manage the Notice of Privacy Practices, and oversee BAA lifecycle for all vendors and SNF partners. Lead breach investigation and notification workflows; coordinate with Melvin Law Group on any reportable incident. Own and maintain the full CAIT/Dozee SOP library (currently seven SOPs, v2.1) — initiate updates within 30 days of any material regulatory change. Manage the annual SOP review cycle; obtain CEO and VP sign-off; track version history and change logs. 4 .Internal Audit — Monthly Claims Sampling Conduct monthly random-sample claims audits (minimum 10% of submitted claims) — verify documentation completeness, code accuracy, and consent/care-plan compliance. Track audit findings in the Compliance Tracking Log; elevate repeat findings to VP Administration; implement and verify corrective actions within agreed timelines. Design, deliver, and track annual compliance training for all clinical, billing, and administrative staff — covering CMS billing rules, HIPAA, AKS, and the OIG RPM Compliance Framework. Maintain training attestation records in Circle Health Domain 0.2; generate compliance attestation reports for VP and CEO annually. 6. Overpayment Management — 60-Day Rule Enforcement Maintain the Overpayment Tracking Log; ensure all identified overpayments are investigated, classified (isolated vs. systemic), and refunded within the 60-day statutory deadline. Coordinate with the Billing Manager on MAC refund submissions; consult Melvin Law Group on any systemic overpayment before refund. 7. Regulatory Intelligence & State Monitoring Monitor applicable state NP practice act changes across CAIT's six operating states (TX, OH, PA, FL, NY, MO) and Dozee's expansion targets. Track RHTP, THRIVE, and NIH grant compliance obligations as Dozee enters new government programs. 8. Contract & AKS Compliance Support Review all SNF partner and vendor agreements against the Anti-Kickback Statute checklist before execution; elevate any FMV or referral-contingency concerns to VP Administration and Melvin Law Group. Maintain executed contract files and the annual contract review schedule. Requirements Experience : Minimum 5 years in healthcare compliance — Medicare billing, HIPAA, or post-acute / RPM environment strongly preferred. Certifications: Certified in Healthcare Compliance (CHC) required or obtainable within 12 months of hire. CHPC (privacy) a plus. Technical : Working knowledge of CPT coding (99453–99470), CMS PFS Final Rules, OIG Work Plan, MAC audit processes, and AKS/Stark safe harbors. Skills : Strong SOP writing, audit documentation, and cross-functional communication skills. Ability to deliver training to clinical and non-clinical staff. Systems : Familiarity with healthcare compliance platforms (preferred); proficiency in Microsoft 365 required. Education : Bachelor's degree required; healthcare administration, law, or clinical field preferred. #J-18808-Ljbffr