[Hiring] Compliance & Investigations Manager @PT Solutions Physical Therapy

Role Description

The Compliance & Investigations Manager supports the organization’s Compliance and Risk Management functions through the oversight and execution of complex investigations, operational risk reviews, and regulatory compliance assessments. This role is responsible for conducting thorough investigations related to compliance hotline reports, risk management events, billing and coding concerns, regulatory matters, and operational issues across multiple healthcare settings.

The Compliance & Investigations Manager is expected to move beyond transactional investigation management by performing deep-dive analyses to identify root causes, operational vulnerabilities, systemic trends, and opportunities for process improvement. This position partners closely with operational leaders, Human Resources, Legal, Revenue Cycle, Clinical Leadership, and other departments to develop corrective action plans and risk mitigation strategies designed to reduce organizational risk and strengthen regulatory compliance.

Qualifications

• Strong analytical, interviewing, investigative documentation, and problem-solving skills.
• Ability to identify systemic operational risks and recommend meaningful corrective actions.
• Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, Compliance, Legal Studies, or related field.
• Minimum of five (5) years of experience in healthcare compliance, healthcare investigations, risk management, auditing, revenue integrity, or related healthcare regulatory role.
• Demonstrated experience conducting complex healthcare investigations independently.
• Strong working knowledge of:
  • Healthcare billing and coding
  • CMS regulations
  • HIPAA/privacy requirements
  • Fraud, waste, and abuse concepts
  • Healthcare operational workflows
• Experience working within multiple healthcare settings such as outpatient clinics, physician practices, hospital-based departments, ambulatory care, or rehabilitation services.

Requirements

• Conduct complex compliance, operational, privacy, billing, coding, and risk management investigations across multiple healthcare settings.
• Manage investigations originating from the Compliance Hotline, Risk Management Event Reporting System, leadership referrals, regulatory concerns, and internal audits.
• Conduct witness interviews, review documentation, analyze supporting evidence, and prepare detailed investigation reports and summaries.
• Ensure investigations are conducted thoroughly, objectively, confidentially, and in accordance with organizational policies and regulatory expectations.
• Track and trend investigation activity to identify recurring operational, compliance, and patient safety risks.
• Perform detailed root cause analyses to identify underlying process failures, operational breakdowns, and systemic vulnerabilities contributing to events or allegations.
• Develop actionable recommendations and corrective action plans aimed at reducing future risk exposure and improving operational performance.
• Collaborate with operational leaders to implement process improvements and monitor effectiveness of mitigation strategies.
• Identify trends and emerging risk areas requiring proactive intervention or monitoring.
• Review allegations and event reports for potential regulatory, billing, coding, fraud/waste/abuse, HIPAA/privacy, or operational compliance concerns.
• Analyze healthcare billing and coding documentation for potential compliance or reimbursement risk.
• Assist in the evaluation of operational practices to ensure compliance with CMS requirements, healthcare regulations, accreditation standards, and organizational policies.
• Support regulatory readiness activities and operational compliance reviews across outpatient, physician practice, and hospital-based healthcare settings, including HOPD environments when applicable.
• Prepare executive-level summaries, investigation findings, trend reports, and recommendations for leadership review.
• Partner with Compliance, Risk Management, Revenue Cycle, Legal, Human Resources, Operations, and Clinical teams on investigations and corrective actions.
• Participate in organizational risk assessments, auditing activities, and compliance initiatives as needed.
• Support the organization’s overall compliance and risk reduction strategy through proactive operational engagement and analysis.

Benefits

• Compensation: $90,000 - 95,000 annually (Any posted pay range considers a wide range of compensation factors, including candidate background, experience, and work location, while also allowing for salary growth within the position).

Company Description

At PT Solutions, we’re more than colleagues; we’re a tight-knit community united in our mission to expand access to quality care. Our commitment to you is evident in our industry-leading professional development opportunities. From ongoing evidence-based clinical education to dedicated mentorship opportunities and an APTA-accredited Orthopaedic Residency Program, we propel our clinicians toward excellence in physical therapy, occupational therapy, speech-language pathology, and athletic training.

As we aim to be the go-to rehabilitation provider, we seek committed professionals eager to join us in that mission. A career with PT Solutions is an opportunity to shape the industry and make a lasting impact.

Let’s go further together and transform care. Join the #PTSLife today!

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