Job SummaryThis Compliance Liaison Specialist Senior position serves as the primary compliance partner supporting Quality, Medicare Stars, and Pharmacy operations. The role provides guidance on regulatory requirements, monitoring and auditing activities, investigations, corrective action plans, and compliance education while partnering closely with operational leaders to promote regulatory adherence and program effectiveness.
Responsible for creating, facilitating and maintaining positive relationships between client groups and the Compliance department to support and sustain an effective compliance program. With limited supervision, acts as a resource to leaders/team members regarding policy and regulatory issues, monitoring and auditing activities, corrective action guidance, and education assistance. Provides ongoing consultations to support leaders with day-to-day compliance. Lead projects and facilitates collaboration with additional compliance functional areas as needed.
Essential FunctionsEstablishes and maintains effective, collaborative working relationships with delegated client groups including but not limited to team members, leaders, and executives. Provides exceptional customer service; facilitates effective communications to promote team member and leadership engagement. With minimal oversight, deploys systematic processes and partners with the Compliance Centers of Expertise (COEs) as needed in the development and deployment of projects and initiatives.
Collaborates with leaders in building a strong culture of accountability; works with leaders to resolve most routine situations and develops recommendations for appropriate follow up action. Collaborates with the Compliance COEs as needed to ensure consistency in daily practice.
Coordinates, advises, and partners with organizational departments on matters relating to various regulatory agency compliance initiatives and regulations.
Leads or supports audits and investigations of compliance help line calls, privacy incidents, employee complaints, or other compliance contacts or reports. Leads necessary research, documents findings, and follows up with applicable parties through complete resolution. Collects, collates, monitors and audits data and activities to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste, or abuse. From time to time, performs investigations at the direction of legal counsel following appropriate attorney-client privilege guidelines.
Maintains expert knowledge of laws and regulations impacting health care delivery and coverage. Applies laws and regulations in daily situations while educating others through various means including formal training. Leads related assessments to assure compliance. Leads or supports the performance of related assessments to assure compliance to laws, regulations and policies and procedures.
Leads or provides support to operational compliance committees.
Works with operational leaders and Compliance COEs to develop and monitor internal controls including corrective action in response to investigations and audits to detect and/or prevent illegal, unethical, or improper conduct by team members, agents, affiliated providers or others within the health system.
Required
Bachelor's Degree or equivalent Business, health care operations, nursing or other related area.
5 years of relevant experience Skills, knowledge, abilities typically gained through 5+ years of related experience; health care operations and/or compliance experience desired
Preferred
Education of clinical and non-clinical staff including Medical Staff and mid-level providers.
Conducting investigations, performing interviews and summarizing results and findings.
CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association Org Integrity and Compliance 1 Year Or
CRT-Professional Coder - AAPC American Academy of Professional Coders 1 Year Or
CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association 1 Year Or
CRT-Fraud Examiner (CFE) - ACFE Association of Certified Fraud Examiners 1 Year Or
CRT-Internal Auditor, Certified (CIA) - Institute of Internal Auditors Institute of Internal Auditors 1 Year Or
CRT-IRB Professional, Certified (CIP) - 1 Year preferred Or
CRT-Healthcare Privacy Compliance, Certified (CHPC) -1 Year Or
CRT-Healthcare Research Compliance, Certified (CHRC) - CCB Compliance Certified Board 1 Year Or
CRT-Healthcare Research Compliance, Certified (CHRC) - HCCA Health Care Compliance Association 1 Year
- Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more .
- On-demand pay program powered by Payactiv
- Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
- Optional identity theft protection, home and auto insurance
- Traditional and Roth retirement options with service contribution and match savings
- Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids
Department Name
System Compliance - Corporate
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
8 a.m. to 5 p.m.
Days Worked
Monday to Friday
Weekend Frequency
N/A
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