[Remote] Sr. Compliance Principal at Included Health

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Bachelor's degree with 12 years of relevant experience, or Master's degree with 8 years of experience, or PhD with 5 years of experience, or equivalent combination of education and experience
Extensive knowledge of theories, practices, and design matters related to healthcare compliance
Significant experience developing and leading critical, strategic initiatives within a compliance program
Experience applying healthcare compliance expertise
Experience creating formal networks and coordinating among groups to influence important partners across the organization
Experience with conceptual thinking to understand advanced issues and their possible effects
Recognized internally as a subject matter expert
Expert-level understanding of healthcare laws, regulations, and ethical standards, including HIPAA, CCPA, ACA 1557, the False Claims Act, and the Anti-Kickback Statute
Experience developing and administering compliance audits and understanding of data collection, analysis, and reporting mechanisms to monitor compliance efforts
Capacity to analyze complex data, interpret regulations, and develop effective solutions to intricate compliance issues
Prompt and regular attendance at assigned work location
Ability to remain seated in a stationary position for prolonged periods
Requires eye (requirements appear truncated)
Preferred Qualifications
Expertise in government payor program compliance, such as Medicare, Medicaid, ACA, and Tri-Care
Certification in healthcare compliance (e.g., CHC, CCEP) or privacy (e.g., CIPP, CIPM)
AI governance/compliance experience
Proficiency with compliance case management systems and platforms

Responsibilities

Strategic Leadership & Program Evolution: Lead and contribute to the development of goals and principles in creative and effective ways. Apply broad expertise to address significant and unique compliance issues, using conceptual thinking to understand advanced issues and their possible effects. Serve as an internal subject matter expert, providing expertise on broader organization projects that require an understanding of the wider business
Critical Risk Management: Identify and assess significant and unique compliance risks, including those related to regulatory compliance, HIPAA Privacy, billing and coding/revenue cycle, and federal/state health insurance programs. Design and implement long-term risk mitigation strategies, exercising independent judgment in methods, techniques, and evaluation criteria. Conduct risk assessments and develop corrective action plans
Advanced Monitoring and Auditing: Provide strategic guidance and oversight for monitoring and auditing activities, using insights from findings to inform future program design and long-term preventative measures
Expert Guidance & Internal Influence: Serve as the enterprise-wide subject matter expert, conveying advanced information and persuading diverse team members and audiences. Create formal networks involving coordination among various groups to achieve compliance goals. May direct the activities of others
Cross-Functional Impact: Work on issues where analysis requires evaluation of intangibles, with accountability for results that may affect the entire function

Skills

Key technologies and capabilities for this role

HIPAA ComplianceRegulatory ComplianceRisk AssessmentCompliance AuditingRevenue Cycle ManagementBilling and CodingRisk MitigationStrategic ComplianceHealthcare Regulations

Questions & Answers

Common questions about this position

What qualifications are required for the Sr. Compliance Principal role?

A Bachelor's degree with 12 years of relevant experience, or a Master's degree with 8 years, or a PhD with 5 years, or equivalent combination is required. Extensive knowledge of healthcare compliance theories, practices, and design matters is needed, along with significant experience developing and leading strategic compliance initiatives.

What is the salary or compensation for this position?

This information is not specified in the job description.

Is this a remote position or what is the location requirement?

This information is not specified in the job description.

Who does the Sr. Compliance Principal report to?

You will report into the Corporate Compliance Officer.

What experience makes a candidate stand out for this role?

Candidates with experience applying healthcare compliance expertise, creating formal networks to influence partners across the organization, and using conceptual thinking for advanced issues will stand out. Significant experience leading strategic compliance initiatives and serving as a subject matter expert is key.

Included Health

Healthcare advocacy and specialized care services

About Included Health

Included Health focuses on enhancing the healthcare experience for individuals who often face challenges in accessing quality care. The company provides a variety of services, including primary care, behavioral health, and virtual care, ensuring that members receive timely and appropriate treatment. Their model emphasizes 24/7 on-demand care with a diverse group of providers, allowing for personalized support tailored to complex health needs. Unlike many competitors, Included Health prioritizes underserved populations and partners with employers and consultants to deliver comprehensive healthcare solutions that not only improve health outcomes but also help reduce costs. The ultimate goal of Included Health is to make quality healthcare accessible and understandable for everyone, particularly those who have been overlooked by traditional healthcare systems.

San Francisco, CaliforniaHeadquarters

2020Year Founded

$337.5MTotal Funding

GROWTH_EQUITY_VCCompany Stage

HealthcareIndustries

51-200Employees

Benefits

Along with comprehensive medical, dental and vision plans; all employee spouses and children can access Included Health services at no cost. For time off, take it when you need it with our unaccrued discretionary time off for all exempt employees.

Risks

Competition from Teladoc and Amwell threatens market share.

Post-merger integration challenges could affect service delivery.

Regulatory scrutiny on telehealth may impact operational flexibility.

Differentiation

Included Health offers integrated primary and behavioral health services.

They provide 24/7 on-demand care with diverse providers.

Their data-driven approach enhances healthcare outcomes and reduces costs.

Upsides

Rising demand for telehealth boosts Included Health's virtual care services.

Employers investing in healthcare benefits expand Included Health's client base.

Value-based care models align with Included Health's focus on outcomes.

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