Compliance Manager

About Firstsource

Firstsource is a specialized global business process management partner. We provide transformational solutions and services spanning the customer lifecycle across Healthcare, Banking and Financial Services, Communications, Media and Technology, and other diverse industries.

With an established presence in the US, the UK, India, Mexico, Australia, and the Philippines, we act as a trusted growth partner for leading global brands, including several Fortune 500 and FTSE 100 companies.

Job Summary

The Compliance Manager is responsible for ensuring that the organization adheres to all federal, state, and local regulations and contractual requirements related to healthcare payer operations. This role involves implementing and overseeing compliance programs, conducting audits, training staff, and mitigating risks to ensure regulatory compliance with regulatory agencies and client requirements.

Additionally, the Compliance Manager will be responsible for mapping regulatory requirements to in-scope BPaaS functions to ensure that operational workflows, processes, and controls align with evolving compliance obligations.

Key Responsibilities

Regulatory Compliance & Policy Management

• Under the direction of the Compliance Officer, implement, and maintain compliance policies and procedures in accordance with CMS, HIPAA, ACA, NCQA, state regulations, and other applicable standards.
• Monitor compliance with regulatory and contractual requirements, ensuring that all BPaaS operational processes align with established compliance frameworks.
• Ensure adherence to internal compliance policies and external regulatory requirements.
• Develop and maintain regulatory requirement mapping documents to align with BPaaS service functions, providing visibility into compliance dependencies across key business operations.

Audit & Risk Management

• Under the direction of the Compliance Officer, conduct internal audits and review compliance reports to identify potential compliance risks.
• Work with external auditors and regulatory agencies during compliance reviews and examinations.
• Under the direction of the Compliance Officer, develop end oversee corrective action plans to address identified compliance gaps.
• Assess compliance risks related to outsourced BPaaS functions and collaborate with operational teams to implement necessary controls and mitigation strategies.

Training & Education

• Ensure that training is completed by employees on compliance policies, fraud, waste, and abuse (FWA), HIPAA, and other regulatory requirements.
• Ensure staff and BPaaS operations teams understand and follows federal and local healthcare regulations.
• Develop and deliver targeted compliance training for BPaaS stakeholders, focusing on how regulatory requirements translate into day-to-day operational execution.

Investigations & Incident Management

• Assist in the investigation of reports of non-compliance, ethical violations, or regulatory concerns.
• Collaborate with legal and compliance, and HR teams to handle compliance-related complaints and issues.
• Oversee the reporting system for compliance concerns.
• Work with BPaaS operations leadership to proactively address compliance concerns and implement necessary process improvements.

Reporting & Documentation

• Prepare reports on compliance activities, audit findings, and corrective actions for the Compliance Committee, senior management, client, and regulatory agencies.
• Maintain accurate documentation of compliance policies, audits, and investigations.
• Ensure BPaaS-related compliance documentation is maintained, including process workflows, regulatory mapping, and operational controls.

Qualifications:

Education & Experience:

• Associate’s degree in Healthcare Administration, Business, Law, or a related field (Bachelor’s preferred).

• 3+ years of experience in healthcare or operational compliance, preferably within a payer organization.
• 3+ years of experience in healthcare or operational compliance, preferably within a payer organization or BPaaS environment.
• Experience with compliance integration in outsourced healthcare services, including CMS regulations, HIPAA, Medicare, Medicaid, and commercial insurance compliance.

Skills & Competencies:

• Fluent in Spanish and English

• Knowledge of healthcare laws and regulations.
• Good analytical, problem-solving, and risk assessment skills.
• Strong communication and training abilities.
• Ability to manage multiple projects and meet deadlines.
• Experience working with compliance frameworks in outsourced or third-party service models, including BPaaS. Strongly preferred.

Firstsource maintains a Drug-Free Workplace.  The company participates in E-Verify and we will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS), with information from each new employee’s I-9 to confirm work authorization.

It is the policy of this Company to seek and employ qualified individuals at all locations and facilities, and to provide equal employment opportunities for all applicants and employees in recruiting, hiring, placement, training, compensation, insurance, benefits, promotion, transfer, and termination.