Clinical Compliance Manager
2 days ago
Austin
Job Description Texas Health Action (THA) is a community-informed non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment, with expertise in serving LGBTQIA+ people and those impacted by HIV. Kind Clinic proudly serves Texas with four vibrant locations: two in Austin, one in San Antonio, and another in Dallas plus virtual care services available to all residents across Texas. Bolstered by Waterloo Counseling Center and a passionate team of over 250 dedicated employees and volunteers, THA is at the forefront of promoting healthcare equity and accessibility throughout the state. Read more about THA here: . The Clinical Compliance Manager provides advanced leadership in clinical compliance, clinical risk mitigation, documentation integrity, and regulatory preparedness. The role ensures that all clinical operations adhere to federal and state regulations, payer requirements, accreditation standards (e.g., URAC, Joint Commission, PCMH), infection prevention protocols, and internal quality expectations. Core Functions: • Lead clinical documentation, coding, and medical necessity audits (E/M, telehealth, specialty services, risk adjustment) and deliver actionable findings, provider education, and trend analysis, • Provide compliance oversight of provider competency, onboarding, credentialing, and privileging processes in alignment with regulatory and accreditation requirements, • Support clinical governance through participation in peer review, performance reviews, quality councils, and multidisciplinary committees, • Oversee infection prevention and clinical safety compliance, including immunization protocols, exposure control, incident reporting, and environmental rounds, • Identify clinical safety risks, conduct incident reviews and root-cause analyses, and track remediation to completion, • Drive regulatory readiness for accreditation surveys, payer audits, and inspections through gap analysis and compliance assessments, • Provide governance and oversight for peer review and utilization review programs to ensure appropriateness of care and adherence to payer and evidence-based standards, • Lead development, review, and implementation of clinical policies, procedures, and practice guidelines aligned with evidence-based standards, • Develop and deliver system-wide education on clinical compliance, documentation accuracy, emerging regulations, and quality standards, • Monitor, analyze, and report clinical compliance metrics, audit results, and risk trends to clinical and executive leadership, • Partner closely with Continuous Quality Improvement (CQI), Risk, and Corporate Compliance teams to translate regulatory findings into sustainable quality improvement initiatives Compensation Based on the position’s duties and requirements, this role has a starting annual salary of $102,335. The initial salary will be determined by the selected candidate’s qualifications and relevant experience. Requirements Education & Certification • Bachelor’s degree in nursing, health information management, healthcare administration, or a related field required; clinical licensure (RN, PA, NP, LVN, RT, etc.) is strongly preferred., • Certification preferred: CIC, CPHQ, CCS, RHIA/RHIT, CHC, or other clinical/quality/compliance credentials. Experience • 3–5 years of experience in clinical compliance, quality management, HIM/coding, infection control, or clinical operations., • Strong working knowledge of clinical documentation standards, coding regulations, accreditation requirements, and payer medical necessity guidelines., • Experience with EHR systems, audit tools, incident reporting systems, and clinical quality analytics., • Prior experience working with LGBTQIA+ and/or other marginalized communities strongly preferred. Knowledge Skills and Abilities • Must have basic PC skills that include a combination of working in a Windows Operating System and Microsoft Outlook, Word, and Excel., • Understands the importance of maintaining confidentiality; able to maintain confidentiality under HIPAA standards., • Must have the ability to exercise a high degree of diplomacy and tact; excellent customer services and interpersonal communication skills; Cultural sensitivity and demonstrated ability to work with diverse people groups., • Well-developed verbal and written communication skills in English; Additional language abilities desirable., • Ability to work well under pressure with minimal supervision., • Ability to effectively interact with persons of widely diverse roles, backgrounds, cultures, and socio-economic classes, those in crises or resistant or negative toward organizations., • Ability to apply time management practices to prioritize, schedule and complete work effectively to comply with mandated policies and deadlines., • Ability to work on multiple tasks or parts of tasks simultaneously to ensure timely completion of work activities., • Must be able to work productively with other departments and employees., • Ability to work with professionals from various partners and organizations., • Usually works forty (40) hours per week, some weekends may be required., • Ability to successfully manage conflict, negotiating “win-win” solutions., • Must be able to multi-task, prioritize with strong time management skills., • Exceptional follow-through on tasks and assignments, • Must possess leadership qualities and be able to supervise and secure the cooperation of staff Physical Requirements/Environmental Conditions Perform the following with or without reasonable accommodations: • Ability to stoop, kneel, crouch, crawl, reach, stand, walk, push, pull, lift, grasp, and be able to perceive the attributes of objects such as size, shape, temperature, and/or texture by touching with skin, particularly that of the fingertips., • Ability to express and exchange ideas via spoken word during activities in which they must convey detail or important spoken instructions to others accurately, sometimes quickly and loudly., • Hearing to perceive the nature of sound with no less than 40 db loss @ Hz, 1000 Hz, and 2000 Hz with or without correction; ability to perceive detailed information orally and make fine discriminations in sound., • Perform repetitive motions with wrists, hands, and fingers. Individual must be able to exert up to 100 pounds of force occasionally and to be able to lift, carry, push, pull, or otherwise move objects., • Work requires a minimum standard of visual acuity with or without correction that will enable people in the role to complete administrative and clerical tasks, as well as inspect and analyze., • Must be able to work and concentrate amidst distractions such as noise, conversation, and foot traffic; ability to handle interruptions often and be able to move from one task to another., • Health Care Plan (Medical, Dental & Vision), • Retirement Plan (403b), • Life Insurance (Basic, Voluntary & AD&D), • Paid Time Off (Vacation, Sick & Holidays), • Short-Term & Long-Term Disability, • Training & Development, • Parental Leave, • Longevity Pay Applicant Information • Submitting official transcripts, diplomas, certifications and licenses may be required prior to final offer. Unofficial transcripts and copies of other relevant documents may be attached to the application for consideration in advance., • Information regarding employment history as it relates to the qualifications of the position may be needed for employment verification., • The applicant selected for employment is subject to a pre-employment background check. A history of conviction may not automatically disqualify an applicant. Applicants with a history of conviction may be considered on a case-by-case basis, after individualized assessment of factors including the nature of the conviction, the job duties and responsibilities, the length of time since the conviction, and evidence of mitigation or rehabilitation. If required for the position, a physical, motor vehicle record evaluation, and additional background checks may be conducted. EEO Statement: Texas Health Action is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.