Clinical Compliance Professional, CenterWell

About the position Be a part of our caring community and help us put health first. CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsible for assessing, investigating, auditing, and validating the mitigation of compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering collaborative relationships with business partners to uphold ethical standards and mitigate risks. The Senior Compliance Professional will support the Director of Compliance by ensuring compliance with governmental requirements for clinics across both federal and state requirements. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. As the Senior Compliance Professional, you will develop and/or evaluate compliance policies and procedures, research compliance issues, and recommend changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. You will participate in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. This role would also be the lead to help develop risk analysis reporting for both the clinic compliance metrics and M&A activity within the PCO.

Responsibilities

• Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.
• Executes assigned portions of the PCO compliance workplan throughout the year.
• Regularly conducts compliance related audits to assess internal controls, examining healthcare records and processes, and analyzing and reporting risks.
• Influences department strategy by identifying and overseeing the development of continuous monitoring activities.
• Provides reporting on metrics and M&A activity.

Requirements

• Bachelor's degree.
• 2 or more years in healthcare related field.
• Compliance regulations knowledge and compliance auditing experience.
• Knowledge/understanding of laws and regulations governed by the DOJ and CMS.
• Must be able to work core business hours on EST time between (9am-4pm).
• Ability to travel up to 15% to conduct audits at site locations.
• Effective verbal and written communication skills.
• Strong attention to detail.
• Ability to articulate findings and impacts.
• Familiarity with healthcare provider compliance, mainly primary care, hospital, and/or pharmacy.
• Ability to manage multiple competing priorities and meet deadlines.
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences.

Nice-to-haves

• CHC certification or similar.
• Medicare Risk Adjustment Experience.
• Clinical background preferred, with Part B and Specialist experience a plus.
• Ability to analyze large data sets.
• Experience or knowledge of Accountable Care Organizations (ACO) preferred.
• Six Sigma or Lean Certified.
• Graduate degree, MBA or Healthcare focus a plus.
• Experience with metrics and reporting.

Benefits

• Medical, dental and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, volunteer time off, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.

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