Senior Healthcare Risk Management Professional

6 days ago

Juneau, Alaska, United States Centerwell Full time
About the Role

**Job Summary**

We are seeking a highly skilled Senior Healthcare Risk Management Professional to join our team at CenterWell. As a key member of our organization, you will play a critical role in identifying and analyzing potential sources of loss to minimize risk.

Key Responsibilities

  • Develop and implement compliance policies and procedures to ensure adherence to governmental obligations.
  • Research compliance issues and recommend changes to ensure compliance with relevant laws and regulations.
  • Estimate the potential consequences of an occurring loss and implement controls and cost-effective approaches to minimize the organization's risks.
  • Make decisions on moderately complex to complex issues regarding the technical approach for project components and work without direction.
  • 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.
  • Prepare compliance reports, guidance memoranda, and data analytics for internal senior management, or regulatory agencies as required.
  • Ensure that project/department milestones/goals are met.
  • Contribute to annual and longer-range development and implementation of the company's risk and compliance assessment plans and compliance work plans.
  • Proactively identify and address compliance issues, and effectively integrate compliance risks/issues and business knowledge to address compliance issues and/or identified risks.
  • Lead and/or participate, 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.
  • Develop and provide compliance training.
  • Assist risk and compliance management and senior leaders with federal, state, and/or administrative disclosure requirements.
  • Review data to determine instances of suspected fraud, waste, and abuse.
  • Where applicable, manage outside vendors to ensure on-time, on-target, and within-budget deliverables.
  • Assist with other Risk Management Department duties and/or projects as assigned.

Requirements

  • 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.
  • 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.

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