Option Care Health

Manager, Compliance Investigations

Option Care Health

full-time

Posted on:

Location Type: Remote

Location: Illinois • United States

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Salary

💰 $112,439 - $187,406 per year

About the role

  • 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.

Requirements

  • 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.
Benefits
  • Medical, Dental, & Vision Insurance
  • Paid Time off
  • Bonding Time Off
  • 401K Retirement Savings Plan with Company Match
  • HSA Company Match
  • Flexible Spending Accounts
  • Tuition Reimbursement
  • myFlexPay
  • Family Support
  • Mental Health Services
  • Company Paid Life Insurance
  • Award/Recognition Programs
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
investigative skillsevidence analysisdata analysisroot cause analysiscompliance assessmentconfidentiality managementrisk managementbilling and coding knowledgehealthcare compliancefraud detection
Soft Skills
attention to detailgood judgmentcommunication skillsinterpersonal skillsrelationship buildinginfluencing stakeholdersproblem-solvingcritical thinkingself-motivationteam collaboration