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Senior Healthcare Risk Management Professional

3 months ago

Lincoln, United States CenterWell Full time

**Become a part of our caring community and help us put health first**

The Senior Healthcare Risk Management Professional identifies and analyzes potential sources of loss to minimize risk. The Senior Healthcare Risk Management Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

**The Role**

The Senior Healthcare Risk Professional develops and implements compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with governmental obligations. The Senior Healthcare Risk Professional estimates the potential consequences of an occurring loss and implements controls and cost-effective approaches to minimize the organizations risks. Makes decisions on moderately complex to complex issues regarding the technical approach for project components and work without direction. The Senior Healthcare Risk Professional will:

+ Manage compliance program oversight of the business by estimating risk, driving auditing and monitoring activities, providing compliance guidance to the business, and tracking relevant laws and regulations and staying current on changes impacting healthcare compliance.

+ Prepares compliance reports, guidance memoranda, and data analytics for internal senior management, or regulatory agencies as required.

+ Ensures that project/department milestones/goals are met.

+ Contributes to annual and longer-range development and implementation of company's risk and compliance assessment plans and compliance work plans.

+ Proactively identifies and addresses compliance issues, and effectively integrates compliance risks/issues and business knowledge to address compliance issues and/or identified risks.

+ Leads and/or participates, with limited direction, in cross-functional internal committees, and can represent the Risk Management Department on cross-functional review/decision-making committees of significant impact across the organization.

+ Develops and provide compliance training.

+ Assist risk and compliance management and senior leaders with federal, state, and/or administrative disclosure requirements.

+ Reviews data to determine instances of suspected fraud, waste, and abuse.

+ Where applicable, manages outside vendors to ensure on-time, on-target, and within-budget deliverables; and

+ Assists with other Risk Management Department duties and/or projects as assigned.

**Use your skills to make an impact**

**Required Qualifications**

+ Bachelor's Degree in a related discipline

+ A minimum of five years of work experience in healthcare compliance, corporate compliance, healthcare risk management, healthcare policy, legal, or relevant field

+ Knowledge/understanding of laws and regulations as it relates to healthcare compliance in Medicare, Medicaid, and/or clinical industries (includes anti-kickback and Stark statutes, government fraud, waste, and abuse, false claims, HIPAA/ Privacy, grievances, patient electronic record surveillance, release of information, etc.)

+ Excellent verbal, interpersonal, and written communication skills

+ Proven ability to synthesize and summarize complex and/or voluminous content into clear, concise, and actionable communications communication.

+ Experience effectively identifying, developing, and implementing process improvements; to include 'outside of the box' solutions.

+ Excellent in building and cultivating relationships with key business partners and stakeholders across organizational levels.

+ Excellent project management skills: can prioritize multiple tasks and goals to ensure timely, on-target and within-budget accomplishment of such.

+ Demonstrates intermediate computer skills including Microsoft Office suite of software applications in Excel and PowerPoint

**Preferred Qualifications**

+ Graduate or advanced degree

+ Previous experience in a healthcare provider organization strongly preferred.

+ Prior Medicare and/or Medicaid, Medicare Advantage, or government oversight strongly preferred.

+ Healthcare Compliance Certification or other relevant professional certification

**Additional Information**

+ Ability to travel to the various clinic locations;