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Option Care Health · 11 hours ago

Manager, Compliance Investigations

Itasca, IL

Full-time

Hybrid

Mid, Senior Level

$112K/yr - $187K/yr

4+ years exp

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. The Manager, Compliance Operations & Investigations supports the compliance investigation program by managing investigations from intake through resolution and collaborating with cross-functional partners to mitigate compliance risk.

Health CareHospitalWellness

Responsibilities

Conduct investigations into fraud, waste, abuse, and other compliance concerns, ensuring thorough, objective analysis and documentation

Support management of the company’s confidential Ethics & Compliance Hotline including intake, case management workflow, reporting, analytics, and vendor relationships

Maintain accurate case records in the Compliance case management system

Develop, implement, and maintain investigation strategies, policies and processes to identify and address potential violations of laws, regulations, and internal policies

Collaborate with cross-functional partners to assess, triage, and route investigative matters for appropriate resolution and risk mitigation. Consult with Legal on compliance-related legal issues and timely communicate relevant statutory, regulatory or policy changes to business unit leadership

Conduct root cause analysis and implement corrective actions. Monitor and track remediation completion

Prepare and present investigation reports to leadership and regulatory authorities, as necessary

Provide guidance on compliance policies, procedures, and best practices and foster a culture of ethical conduct and non-retaliation

Maintain current knowledge of relevant healthcare laws and regulations (e.g., HIPAA, Stark Law, Anti-Kickback Statute, and False Claims Act). Help ensure investigative practices remain current and compliant

Support Compliance activities related to conflict-of-interest disclosure review and response

Ensure confidentiality of sensitive business and patient information. Maintain records consistent with Option Care Health policy and Compliance Department processes

Support compliance integration initiatives with new business models

Qualification

Investigative skillsHealthcare compliance knowledgeRoot cause analysisAnalytical skillsMicrosoft ExcelCompliance certificationsCommunication skillsInterpersonal skillsProblem-solving skillsAttention to detailSelf-motivated

Required

Bachelor's degree or Associate degree, preferred in healthcare, business, legal, justice, or related field

Minimum 4-6 years of progressive experience in investigations, healthcare compliance, or risk management, including at least 2-4 years in a role overseeing or conducting investigations

Strong investigative skills and experience, including interviewing, evidence analysis, attention to detail, and good judgment

Ability to conduct thorough, objective and complex investigations, analyze complex data sets, and draw actionable conclusions

Knowledge of healthcare laws and regulations, including billing and coding, privacy and security, and fraud, waste and abuse (e.g., HIPAA, Anti-Kickback, Stark, Medicare and Medicaid reimbursement)

Experience assessing compliance with applicable laws, regulations, standards, and internal policies

Experience interacting with senior management, legal counsel, federal and state regulators, and law enforcement

Excellent communication and interpersonal skills, with the ability to build relationships, influence stakeholders, and clearly communicate investigative findings

Experience identifying operational issues and recommending effective solutions

Experience managing multiple investigations simultaneously, prioritizing work effectively, and providing regular status updates to leadership

Strong analytical, problem-solving, and critical-thinking skills

Self-motivated, accountable for personal growth, and supportive of others' development, while fostering an inclusive team environment and engaging in continuing education opportunities and connection

Ability to handle sensitive and confidential information with professionalism

Intermediate level skill in Microsoft Excel, Microsoft Word and Microsoft PowerPoint

Ability to sit and work on a computer for extended periods of time

Willing to travel up to 25% of the time for business purposes (within state and out of state)

Preferred

Certified in investigation tactics, interviewing, fraud examination, and/or compliance (e.g., CFE, AHFI, CHC, CPCO)

Advanced degree (e.g., JD, MBA, MPH) or clinical certification

At least 2 years of direct experience in a compliance role for home infusion services, pharmacy, nursing, or large payor organization

At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care regulatory requirements

Experience using common third-party software solutions for Compliance and Privacy program management of incidents, investigations, monitoring and exclusion screening (such as Navex, internal case management systems, etc.)