Navitus Health Solutions · 4 days ago
Sr. Manager, Compliance
United States
Full-time
Remote
Mid, Senior Level
$83K/yr - $101K/yr
4+ years exp
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Responsibilities
Facilitates specialty pharmacy and related compliance, OIG risk, audit, and risk strategic initiatives, which support the organizational strategic plan.
Independently investigate cases of Lumicera non-compliance in accordance with the investigation protocols and procedures, including root cause analyses.
Oversees, supports and/or provides consultation for established or emerging areas of compliance with specialty pharmacy influence including but not limited to medical billing, PCI-DSS standards, home infusion, Telephone Consumer Protection Act, SOC, HITRUST, and Section 508 accessibility.
Prepares reports to keep executive leadership and the Lumicera Board of Directors informed on the progress and effectiveness of compliance efforts.
Ensures compliance presence in departmental interfaces, cross-training, and educational materials for Lumicera.
Evaluate, review and/or modify policies or operating guidelines to comply with changes to payer requirements or regulations.
Serve as a confidential point of contact for employees to communicate with management, seek clarification on issues or dilemmas, or report irregularities.
Participates in Sales activities, including RFP responses for manufacturers and payers and potential client presentations.
Other duties as assigned
Qualification
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Required
A minimum of a Bachelor’s degree is required, preferably in criminal justice, risk management, healthcare, compliance-related field and/or pharmacy.
A minimum of four (4) years’ experience in pharmacy and/or healthcare compliance, claims investigations and/or auditing is highly desired.
Demonstrated experience in a leadership role required.
Knowledge of Medicare and Medicaid billing and third-party payer billing regulations and reimbursement is also highly desired.
Knowledge of specialty pharmacy or healthcare compliance and other state/federal laws that govern specialty pharmacy and related services.
Participate in, adhere to, and support compliance program objectives.
The ability to consistently interact cooperatively and respectfully with other employees.
Preferred
Certification in Healthcare Compliance (CHC) preferred or agreement to obtain within 1-2 years of employment.
Experience in home infusion, healthcare payment, medical billing, and URAC and/or ACHC accreditation quality program oversight strongly preferred.
Benefits
Top of the industry benefits for Health, Dental, and Vision insurance
20 days paid time off
4 weeks paid parental leave
9 paid holidays
401K company match of up to 5% - No vesting requirement
Adoption Assistance Program
Flexible Spending Account
Company
Navitus Health Solutions
Navitus Health Solutions LLC is a full service, URAC-accredited pharmacy benefit management company.
1,001-5,000 employees
Funding
Current Stage
Late StageLeadership Team
Shayna Schulz
Chief Operations Officer
Recent News
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