Provider Operations Compliance, Program Manager (Jefferson Health Plan) at Jefferson Health in Philadelphia, PA

Job description

Number of Positions In Requisition 1

 Job Details The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency. Job Description Summary The Compliance Program Manager is responsible for overseeing compliance activities across all lines of business, including Medicare, Medicaid, CHIP, and ACA. This role ensures policies and procedures align with requirements, manages internal and external audits, and leads the development of corrective action plans. The manager conducts routine monitoring, supports regulatory reporting, identifies compliance risks, and drives operational improvements. This position also serves as a key liaison between Compliance and Operations teams, helping to maintain audit readiness and promote a culture of accountability and efficiency. Job Duties Ensure Regulatory Compliance: Track and maintain all compliance activities across all lines of business and work with units within the department to complete. Compliance activities include but are not limited to: External day-to-day inquiries, Internal/ External Audit Deliverables, Regulatory reporting Review department policies, procedures and desktop procedures to ensure they meet regulatory requirements. Conduct Monitoring, Auditing and Improvement Action Plan Activities within internal Teams: Conduct monitoring for all lines of business (Medicare, Medicaid, CHIP and ACA) according to departmental processes and workflows. Perform scheduled audits according to Compliance Work Plan Perform ad-hoc targeted regulatory audits as needed. Oversee the development, implementation and management of departmental improvement action plans initiated by internal and/or external audits by conducting root cause analysis, track progress, educate on audit errors and ensure timely completion of corrective measures. Audit & Meeting Management: Provide leadership in audits and reviews by regulatory bodies. Ensure accurate data collection and timely submission. Compile audit findings and report to executive management and internal committees as needed. Prepare assigned teams for internal and/or external regulatory audits by reviewing previous audit material and results and ensuring that department is ready and available to meet the needs of active and upcoming audits. Serve as the Compliance liaison for facilitating monthly Compliance team’s meetings. Risk Mitigation: Research trends and identify areas that present potential risk to the departments. Utilize identified potential risks related to non-compliance to develop internal department improvement action plans to address deficiencies. Support Organizational Strategy: Assist in developing, producing, and conducting compliance training programs for staff to understand regulatory requirements. Improve Efficiency: Enhance operational efficiency by standardizing regulatory workflows. Support and deliver regulatory reporting and performance initiatives. Minimum Qualifications Bachelor’s Degree in a relevant field such as: Business Administration, Healthcare Administration, Public Health, Compliance, Risk Management, or a related field 5 years of experience in: Compliance, auditing, or risk management, Healthcare operations or a highly regulated industry, Managing or coordinating internal/external audits or Developing or overseeing compliance monitoring activities Strong analytical and critical thinking skills to assess compliance risks and identify solutions. Excellent