Senior Clinical Compliance Professional

Employment Type: Full time

Position Overview

CenterWell Senior Primary Care (PCO) is seeking a Senior Clinical Compliance Professional to join its growing Regulatory Compliance team. This team is responsible for assessing, investigating, auditing, and validating the mitigation of compliance risks across the organization. The Senior Clinical Compliance Professional will support the Director of Compliance by ensuring adherence to governmental requirements for clinics at both federal and state levels. This role involves in-depth evaluation of variable factors for moderately complex to complex compliance issues.

Responsibilities

• Develop and/or evaluate compliance policies and procedures.
• Research compliance issues and recommend changes to ensure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes.
• Coordinate site visits for regulators.
• Coordinate the implementation and compliance with corrective action plans, as needed.
• Participate in all phases of the audit process, including evaluating control design and adequacy, testing for adherence to policies and internal controls, and communicating issues and recommendations to management.
• Serve as a regulatory compliance subject matter expert within the 2nd line of defense compliance function.
• Communicate compliance-related requirements to high-level business leaders within the PCO.
• Assess compliance risks to PCO and leverage these assessments to design auditing and monitoring activities for the workplan.
• Execute assigned portions of the PCO compliance workplan throughout the year.
• Conduct compliance-related audits to assess internal controls, examine healthcare records and processes, and analyze and report risks.
• Influence department strategy by identifying and overseeing the development of continuous monitoring activities.
• Provide reporting on metrics and M&A activity related to revenue cycle management.

Requirements

• Bachelor's degree.
• 3 or more years of healthcare experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims).
• Experience with auditing and monitoring of healthcare records.
• Must be able to work core business hours on EST time between 9 am - 5 pm.
• Willingness to travel up to 10% to conduct audits at site locations.
• Ability to manage multiple or competing priorities and meet deadlines.
• Passion for contributing to an organization focused on continuously improving consumer experiences.
• Effective verbal and written communication skills.
• Strong attention to detail.
• Ability to articulate findings and impacts.
• Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS.

Preferred Qualifications

• Compliance regulations knowledge and compliance auditing experience.
• Ability to analyze large data sets.
• Knowledge of healthcare compliance, mainly primary care and risk adjustment; pharmacy knowledge is a plus.
• Certified Coder (CPC, CRC, and/or CMC).
• Experience with metrics and reporting.

Company Information

CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior-focused primary care centers in 15 states. We are a growing provider organization dedicated to putting health first and fostering a caring community.

Work-At-Home Requirements

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided inter...