DescriptionOverviewThe Senior Specialist, Compliance and Ethics will work alongside a dynamic team in our national support center. Working within the Compliance & Ethics Department, this individual will contribute to PDS Health's healthcare compliance and ethics program by creating and directing compliance initiatives and supporting the implementation and adoption of compliance program elements across the organization. Successful candidate will have an engaged, roll-up-your-sleeves approach, with the ability to work closely with internal clients to ensure regulatory compliance while business needs are met; will understand and nurture the philosophy of the PDS Health Compliance & Ethics Program, which is to leverage our organizational values and desired behaviors to inspire team members towards self-governance.
Responsibilities- Exemplify the culture of PDS Health; facilitate the evolution of the PDS culture as a strategic differentiator.
- Proactively identify and help mitigate compliance risks, potential misconduct, and areas of legal or regulatory exposure.
- Oversee education for team members regarding their responsibility to maintain a high level of ethical and legal behavior while performing their duties.
- Provide oversight and support related to compliance with laws, regulations, and special conditions imposed upon PDS Health by licensing or regulatory authorities with respect to its operations.
- Provide effective means for individuals to report allegations of non-compliance; and oversee a process for the implementation of corrective action plans in response to any identified compliance issue.
- Support PDS Health's privacy program, including responding to privacy-related questions, assessing potential privacy/breach incidents, and providing guidance regarding HIPAA and other applicable privacy regulations.
- Develop and deliver compliance training in partnership with Learning and Development to team members on a variety of compliance topics.
- The Senior Specialist is expected to have a foundational understanding of healthcare compliance and privacy concepts, including HIPAA and PHI, healthcare fraud, waste, and abuse, compliance investigations, risk assessments, auditing and monitoring and corrective action processes, and to continue to develop and enhance that existing base of knowledge.
- Draft and implement healthcare and compliance-related policies and procedures while managing the policy lifecycle.
- Perform legal and regulatory research and analysis designed to support team members and provide strategic guidance on commercial programs, initiatives and processes that have healthcare compliance-related implications.
- Perform assigned investigations and compliance program projects following PDS Health standards while keeping management and legal counsel informed of results and completion status.
- Act as a resource within PDS Health to both regional and enterprise teams; answer questions, analyze data, conduct research, conduct interviews, and make recommendations to address regulatory compliance and privacy risks.
- Oversee and monitor ongoing privacy and data protection compliance activities and provide guidance on related requirements; partner with the Information Technology and Risk departments to ensure compliance with policies and procedures.
- Proactively identify potential issues, support risk assessments and audits, and develop work plans to monitor and address identified risks.
- Ensures compliance with all policies and standards, as well as state, federal and other regulatory bodies.
Qualifications- JD or Master's in public health or health services administration, business administration, organizational effectiveness, internal controls, or management.
- 2+ years of job-related experience.
Preferred- Certification in Healthcare Compliance, and/or Healthcare Privacy Compliance, and/or Compliance & Ethics Professional Certification.
- Healthcare compliance experience.
- Internal audit, healthcare privacy compliance, health information management, revenue cycle, health plan and/or government program compliance experience.
Knowledge/Skills/Abilities- Proficient computer skills in MS Word, Excel, Outlook, PowerPoint.
- Base knowledge and expertise in regulatory, healthcare, privacy, and compliance topics.
- Working knowledge of applicable rules and regulations.
- Exercises good judgment.
- Ability to multi-task effectively without compromising the quality of the work.
- Strong communicator (written and verbal) with excellent interpersonal skills.
- Detail-oriented, organized, process focused, problem solver, proactive, ambitious, customer service focused.
- Ability to draw conclusions and make independent decisions with limited information.
- Ability to respond to common inquiries from customers, staff, regulatory agencies, vendors, and other members of the business community.
- Self-motivated, reliable individual capable of working independently as well as part of a team.
Benefits- Medical, dental, and vision insurance
- Paid time off
- Tuition Reimbursement
- 401K
- Paid time to volunteer in your local community
Salary Information$116,000.00-$150,000.00 / Annually
