Orthopedic Care Partners

Compliance

• Manage and conduct non-coding compliance audits and monitoring activities
• Develop audit scopes and tools, evaluate findings, prepare reports, and coordinate corrective actions and follow-up monitoring
• Identify compliance trends, control weaknesses, and potential risks and escalate significant concerns to the Chief Compliance Officer
• Support the development, review, implementation, and maintenance of compliance policies and procedures
• Develop and coordinate compliance and policy education, communications, and related resources
• Administer the Healthicity compliance management system, including audit, policy, incident, education, and reporting functions
• Manage assigned compliance projects and assist with implementation and tracking of Compliance Work Plan activities
• Conduct regulatory research and assist with compliance risk assessments and evaluation of regulatory changes
• Develop compliance metrics, reports, and materials for leadership and compliance governance activities
• Support compliance investigations and other reviews
• Collaborate with operational and corporate departments on compliance initiatives and corrective actions
• Perform additional duties supporting the compliance function under the direction of the Chief Compliance Officer

Compliance Manager

General Counsel

• Provide practical legal advice to senior leaders, physicians, and business partners on healthcare operations, compliance, governance, employment, contracting, transactions, and risk management
• Draft, review, and negotiate physician employment agreements, vendor contracts, professional services agreements, managed care arrangements, leases, and healthcare-related contracts
• Advise on Stark Law, Anti-Kickback Statute, HIPAA, fraud and abuse, licensure, reimbursement, and other laws affecting physician practices
• Support acquisitions, affiliations, new practice locations, physician recruitment, and service line expansion
• Partner with compliance, human resources, finance, operations, and outside counsel on complex legal and business issues

Associate General Counsel

General

• Submit and track insurance and patient claims for government and commercial payers
• Perform timely follow-up on unpaid or denied claims to ensure proper reimbursement
• Conduct root cause analysis on recurring denials or payment issues and escalate trends to management
• Research payer policies and claim-specific requirements
• Process write-offs and adjustments according to established protocols and payer contracts
• Maintain clear, accurate documentation of claim-related activities and communications
• Collaborate with clinical, billing, and coding staff to resolve claim issues
• Monitor aging reports and prioritize follow-up based on payer deadlines and financial impact
• Prepare reports and summaries of problem accounts, denial patterns, and process inefficiencies
• Assist in implementing process improvements to reduce denials and enhance revenue cycle performance
• Ensure compliance with HIPAA, payer guidelines, and internal billing policies
• Perform other duties as assigned

Compliance Manager

Associate General Counsel

Claims Resolution Specialist