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., * 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.

• Servant-Leader
• Adaptable
• Enthusiastic Learner
• Innovative Builder
• Strong Collaborator
• Creative Problem Solver
• Critical and Strategic Thinker, * Agreement with and adherence to PreBorn!’s Statement of Faith and Code of Christian Conduct.
• Willingness to intercede before God for the ministry of PreBorn!. Fidelity to an ever-maturing biblical, evangelical lifestyle.
• Bachelor’s degree required in Health Information Management, Healthcare Administration, Nursing, Public Health, or a related field. (Master’s degree preferred).
• RHIA, RHIT, CCS, CPC, or similar coding certification preferred.
• Deep understanding of telehealth regulatory requirements, billing practices, and payer requirements.
• Positive, team-player with a pro-active approach to problem solving.
• Independent, results-focused, highly organized self-starter.
• Ability to thrive in a fast-paced and dynamic environment, handling multiple priorities with ease and a keen attention to detail, * Minimum 7-10 years of experience in healthcare risk management and quality improvement with at least three years in a leadership role.
• Demonstrated experience in developing and managing payer-provider partnerships, particularly in maternal health and/or high-risk populations.
• Proven experience managing teams and driving performance in a remote or hybrid environment.
• Strong analytical, communication, and project management skills.
• Experience with HER systems and coding software tools.
• Familiarity with value-based care models, quality metrics, and care coordination strategies.

3.73.7 out of 5 stars United States Remote $75,000 - $80,000 a year - Full-time