Clinical and Regulatory Compliance Lead
Cityblock Health is a new type of healthcare company, operating out of Brooklyn and backed by Alphabet’s Sidewalk Labs, along with some of the top healthcare investors in the country.
Our mission is to radically improve the health of urban communities, one block at a time. Importantly, our solutions are designed specifically for Medicaid and lower-income Medicare beneficiaries, and we bring the capability to deliver care in the home and neighborhood with our field-based teams.
In close collaboration with community-based organizations and leading commercial partners, we are reorganizing the health system to focus on what matters to our members. We deliver personalized primary care, behavioral health, and social services through a network of neighborhood hubs with deep community-based partnerships and world-class technology.
We partner with payers and at-risk providers, accepting capitated financial risk to care for their most vulnerable, high and rising risk members. Additionally, we invest in strategic partnerships with community-based and social services organizations, in some instances bringing them into the value equation through sub-capitation and performance-based compensation.
Over the next year we’ll grow quickly, including entering new markets, each with their own commercial relationships and field-based teams. This role will be a key contributor to the success of our business.
The role:
As the inaugural member of our Compliance team, you will build out the privacy and compliance program including, but not limited to, training, policies and procedures, auditing and incident management (working with in-house counsel). You’ll develop and implement a high level strategy to prevent, detect, and mitigate fraud, waste and abuse. You will also create a process for evaluating the CBH compliance program that will drive program goals and priorities for the following year.
You will:
- Develop policies and procedures that ensure regulatory compliance and industry best practice for such issues as HIPAA (e.g. access controls, computer security, phone security), consent, device policies, non-digital data management
- Develops audit and reporting processes, mitigates issues and escalates breaches
- Proactively conducts and/or oversees compliance audits, risk assessments
- Manage Compliance initiated investigations with in-house counsel, including interview/fact finding and analysis, presentation of recommendations to leadership, remediation/root cause process enhancements and ensures corrective action plans are implemented.
- Work with clinical leadership and clinicians to evaluate any compliance risk within our hub and clinical model
- Identify new risks and priorities through various channels, including meetings with stakeholder leadership, internal/external attorneys and collaborates with the operators to implement compliance solutions.
- Assist in the development and execution of the Annual Compliance work plan
- Implement and manage a compliance training strategy for new hires and ensure annual training for current team members.
- Provide education to clinicians on billing and coding. Perform outpatient coding and billing audits to evaluate the appropriateness of medical records to support accurate claims
- Serve as the in-house expert on regulatory compliance, ensuring superior understanding of key regulatory concepts relevant to CMS, Medicaid, FWA laws
- Provide compliance advice to CBH team
- Monitor regulatory, legal and industry developments and identify opportunities for their application to CBH
- Manage anonymous tip line and email
- Manage security audit and associated vendor relationships
You’d be a good fit if:
- You have 5+ years of experience in a healthcare compliance environment
- You bring a superior understanding of key regulatory concepts relevant to CMS, Medicaid, FWA laws
- You have 2+ years of experience managing a team
- You’re highly ethical
- You can present findings and discuss issues with providers confidently and effectively
- You have strong attention to detail and are highly organized
- You bring strong interpersonal, analytical, written/oral communication and presentation skills
- You’re a team player with ability to work well independently and as a group
- You’re flexible, with an ability to work under pressure, multi-task and meet deadlines
Nice to have:
- Certified in Healthcare Compliance (CHC) desirable
- Master’s degree (MBA or MHA) or JD
- Experience with coding/billing
You should include these in your application:
- A resume and/or LinkedIn profile.
- A 1-2 paragraph response indicating why this job is compelling to you.
Cityblock values diversity as a core tenet of the work we do and populations we serve. We are an equal opportunity employer, indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.