Compliance Manager

About the role

The Compliance Manager is responsible for building, executing, and continuously improving Dozee's healthcare compliance program across all regulatory domains — Medicare RPM billing, HIPAA privacy and security, FDA device compliance, and Anti-Kickback Statute adherence. The role reports to the VPAdministration and is the organization's primary day-to-day compliance operator, translating policy into procedure and ensuring every business function performs within established legal and regulatory boundaries.

Responsibilities

• CMS / Medicare RPM Billing Compliance
  • Own the monthly billing compliance review cycle — validate CPT code selection (99453–99470), data-daythresholds, and mutual exclusivity rules before claims are released.
  • Monitor CMS Final Rules, MAC Local Coverage Determinations (LCDs), and OIG Work Plan items affecting RPM billing; brief leadership on material changes within 30 days.
  • Maintain the pre-bill dual-attestation workflow and enforce the 99458 MUE cap and time-counting rules.
• HIPAA Privacy & Security Program
  • Serve as Dozee's designated HIPAA Compliance Officer — conduct annual Security Risk Assessments, manage the Notice of Privacy Practices, and oversee BAA lifecycle for all vendors and SNF partners.
  • Lead breach investigation and notification workflows; coordinate with Melvin Law Group on any reportable incident.
• SOP Development & Version Control
  • Own and maintain the full CAIT/Dozee SOP library (currently seven SOPs, v2.1) — initiate updates within 30 days of any material regulatory change.
  • Manage the annual SOP review cycle; obtain CEO and VP sign-off; track version history and change logs.
• Internal Audit — Monthly Claims Sampling
  • Conduct monthly random-sample claims audits (minimum 10% of submitted claims) — verify documentation completeness, code accuracy, and consent/care-plan compliance.
  • Track audit findings in the Compliance Tracking Log; escalate repeat findings to VP Administration; implement and verify corrective actions within agreed timelines.
• Staff Training & Annual Attestation
  • Design, deliver, and track annual compliance training for all clinical, billing, and administrative staff — covering CMS billing rules, HIPAA, AKS, and the OIG RPM Compliance Framework.
  • Maintain training attestation records in Circle Health Domain 0.2; generate compliance attestation reports for VP and CEO annually.
• Overpayment Management — 60-Day Rule Enforcement
  • Maintain the Overpayment Tracking Log; ensure all identified overpayments are investigated, classified (isolated vs. systemic), and refunded within the 60-day statutory deadline.
  • Coordinate with the Billing Manager on MAC refund submissions; consult Melvin Law Group on any systemic overpayment before refund.
• Regulatory Intelligence & State Monitoring
  • Monitor applicable state NP practice act changes across CAIT's six operating states (TX, OH, PA, FL, NY, MO) and Dozee's expansion targets.
  • Track RHTP, THRIVE, and NIH grant compliance obligations as Dozee enters new government programs.
• Contract & AKS Compliance Support
  • Review all SNF