Compliance Manager- Virtual Care System (VCS)
Scope: We are seeking a Christ-loving, driven and results-oriented Compliance Manager to support our Virtual Care System at PreBorn!. This position oversees the development, implementation, and management of coding and compliance programs specific to clinic and telehealth services for maternal care.
The successful candidate will have the following qualities and characteristics: sold-out Believer in Jesus Christ and committed to PreBorn's mission to Glorify Jesus Christ by saving lives and souls, as well as demonstrated experience in clinical coding, quality and compliance for telehealth medicine. The primary area of responsibility is to ensure adherence to federal and state regulations, payer guidelines, and industry best practices while driving operational excellence and client satisfaction.
Additionally, this position will lead initiatives to develop managed care partnerships focused on care coordination and improving health outcomes for high-risk pregnant women, supporting value-based care models and maternal health equity.
Character Qualities:
• Servant-Leader
• Adaptable
• Enthusiastic Learner
• Innovative Builder
• Strong Collaborator
• Creative Problem Solver
• Critical and Strategic Thinker
Key Responsibilities:
• Lead and manage risk and compliance team, including hiring, training, performance management, quality improvement and professional development.
• Develop and implement policies and procedures to ensure accurate clinical documentation, coding, and billing practices for maternal clinical services.
• Monitor regulatory changes and payer updates related to electronic health records (EHRs), telehealth, and maternal care to ensure timely integration into organizational practices.
• Conduct internal audits and risk assessments to identify compliance gaps and implement corrective actions.
• Serve as a subject matter expert on clinical documentation and general coding (CPT, HCPCS, ICD-10) and compliance regulations (HIPAA, OIG, CMS).
• Collaborate with legal, information technology (IT)/information systems (IS), clinical, and operational teams to ensure cross-functional alignment and compliance.
• Provide strategic guidance to clinic clients on coding and risk mitigation to support regulatory compliance.
• Develop and deliver training programs for internal staff and external clients.
• Represent the organization in industry forums, conferences, and with regulatory bodies as needed.
• Lead the development and management of managed care partnerships aimed at enhancing care coordination and improving maternal health outcomes, particularly for high-risk pregnant women.
• Collaborate with payers, providers, and community organizations to design and implement value-based care models and telehealth-enabled interventions.
• Analyze outcome data and quality metrics to assess program effectiveness and identify opportunities for improvement in maternal and perinatal care.
MISSION PRE-BORN INC is an EEO Employer - M/F/Disability/Protected Veteran Status