Quality and Compliance Manager

Job Summary
The Quality & Compliance Manager is the organization’s primary owner of clinical quality assurance, regulatory compliance, documentation standards, and audit readiness. This role exists to ensure that the care we deliver is not only clinically sound but also fully defensible — to Medicaid auditors, managed care organizations, HHSC reviewers, and any external party that evaluates our performance against contractual, regulatory, or industry standards.

Reporting to the Director of Clinical Operations, the Quality & Compliance Manager works daily alongside the Clinical Manager, Team Leads, and Case Managers to monitor documentation quality, identify compliance risks before they become audit findings, drive corrective action where gaps exist, and establish a culture of continuous improvement across all clinical and operational functions. This is not a back-office compliance role — it is an operational partnership role that is in the workflow, reviewing records, coaching staff, and flagging risks in real time

Responsibilities

• Clinical Documentation Quality Assurance
• Regulatory Compliance & Continuous Audit Readiness
• Team Lead & Supervisor Compliance Partnership
• Quality Standards, Best Practice Benchmarking & Continuous Improvement
• Oversee training programs for staff on compliance protocols, HIPAA privacy rules, ICD coding updates, and documentation best practices.
• Collaborate with cross-functional teams to review clinical documentation for accuracy and completeness in accordance with ICD-10/ICD-9 coding standards.
• Manage incident investigations related to compliance breaches or quality issues, implementing corrective actions promptly.
• Maintain up-to-date knowledge of evolving healthcare laws and regulations to ensure organizational policies remain current.
• Prepare detailed reports for executive leadership on compliance status, audit findings, and areas for improvement.

Qualifications

• Proven experience in healthcare compliance management or quality assurance roles within medical or healthcare settings.
• Strong understanding of HIPAA privacy rules, CPT coding, ICD-9/ICD-10 coding systems, Medicare regulations, FDA guidelines, and JCAHO accreditation standards.
• Demonstrated ability to develop and implement effective compliance programs and conduct thorough audits.
• Excellent communication skills with the ability to train staff on complex regulatory requirements clearly and effectively.
• Analytical mindset with keen attention to detail for reviewing clinical documentation and coding accuracy.

Pay: $20.00 - $25.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

Work Location: In person