Job Description

Overview:

As the Senior Compliance Manager at Sword, you will lead the development and oversight of compliance programs to ensure adherence to federal, and state regulations and guidelines. This includes both internal operations and external compliance across contracted and affiliated provider entities. You will manage monitoring, auditing, and risk mitigation efforts, while serving as a subject matter expert and promoting a culture of ethics and regulatory compliance across the organization and its provider network.

• Develop and Implement Compliance Programs: Design and manage compliance programs encompassing applicable regulatory and other contractual requirements.
• Regulatory Monitoring and Analysis: Stay up-to-date on changes in applicable federal and state regulations, guidance, and other relevant policies.
• Policy Development and Enforcement: Work closely with various internal departments to draft, review, and implement compliance policies, procedures, and standards of conduct, ensuring they align with regulatory requirements and organizational values.
• Compliance Audits and Risk Assessments: Conduct regular internal audits, risk assessments, and monitoring activities to identify potential areas of non-compliance, evaluate effectiveness of controls, and implement corrective actions.
• Training and Education: Develop and deliver training programs on compliance topics to employees, leadership, and third-party vendors, fostering awareness and understanding of obligations.
• Investigate and Report Non-Compliance: Manage and investigate reported incidents of non-compliance and potential Fraud, Waste, and Abuse (FWA), coordinating with relevant teams to implement corrective actions and ensure timely reporting to regulatory agencies.
• Maintain Documentation: Establish and maintain comprehensive documentation and record-keeping systems related to compliance activities, audits, policies, training, and corrective actions.

• Bachelor's degree in healthcare administration, law, business administration, or a related field.
• Proven experience (typically 8+ years) in compliance.
• Familiarity with other relevant healthcare laws and regulations such as HIPAA, Anti-kickback statute, and Stark Law.
• Strong analytical, problem-solving, and critical thinking skills.
• Excellent communication (written and verbal), interpersonal, and negotiation skills.
• Ability to work independently, manage multiple priorities, and meet deadlines.
• Excellent written and verbal communication skills, with the ability to communicate complex concepts effectively.
• Exceptional organizational skills and attention to detail, with the ability to manage multiple priorities in a fast-paced environment.

• Relevant certifications such as Certified Healthcare Compliance (CHC), Certified in Healthcare Privacy (CHCP), Certified in Healthcare Research Compliance (CHRC).
• Experience in a Third-Party Administrator (TPA) environment or similar healthcare setting.
• Knowledge of Medicare regulations, CMS compliance program requirements (7 Core Elements), and guidelines.
• Government compliance experience is a plus.

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