Sr. Ethics & Compliance Spec-GuideWell Source

Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.
 
 
Benefits info:
* Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire
* Short- and long-term disability benefits
* 401(k) plan with company match and immediate vesting
* Free telehealth benefits
* Free gym memberships
* Employee Incentive Plan
* Employee Assistance Program
* Rewards and Recognition Programs
* Paid Time Off and Paid Sick Leave
 
 
 

SUMMARY STATEMENT
The Senior Ethics & Compliance Specialist serves as a senior level individual contributor to the company's Compliance and Ethics Program, the Navigator Program. This role operates with a high level of independence and subject matter expertise to lead complex investigations, perform monitoring activities, and leads the development and delivery of compliance training. The Senior Specialist provides independent support for the Compliance Work Plan execution, prepares key contractual deliverables and contributes to continuous improvement efforts within the compliance function. This role also mentors Specialists 1 and 2, collaborates with HR, Legal, Information Security, Internal Audit, and operational areas, and contributes to the implementation and continuous improvement of the company's compliance initiatives under the direction of the government programs compliance officer.
 
 
ESSENTIAL RESPONSIBILITIES
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This list of essential job functions is not exhaustive and may be supplemented as necessary.

Inquiries and Investigations (30%)
· Review and respond to internal inquiries, escalating to the compliance officer as needed.
· Lead low-, moderate-, and complex investigations, including developing a formal investigation plan, determining and drafting interview questions, leading all interviews, and preparing a clear, structured and well-organized comprehensive investigation report with recommendations for compliance officer review.
· Mentor and support Compliance Specialists 1 and 2 in responding to internal inquiries and conducting investigations, including assisting in the drafting of investigation plans, conducting interviews and investigation report as requested.
· Utilizes data and analytics, inquiry trends, and incident management reporting to identify patterns, anomalies or indicators of compliance risks
· Coordinate with HR, Legal, Information Security, Internal Audit (as appropriate), and operational management to support investigations and ensure appropriate information sharing.

Compliance Work Plan (30%)
· Lead the departmental review of the Navigator Code of Business Conduct and departmental procedures, with recommended updates.
· Perform assigned monitoring activities related to compliance work plan components and draft associated reports for compliance officer review, including, but not limited to leading the development of Compliance Points, supporting the compliance officer in preparing Reportable Events for submission to CMS, and providing support in the preparation of quarterly board and ECC reports and meetings.
· Identify potential risks within operational areas that may impact government contracts.
· Participate in quarterly timekeeping calibration activities and serve as a mentor to Compliance Specialists 1 and 2 by guiding them through sampling audits, reviewing results, and preparing summary findings for the compliance officer.
· Support the Conflict of Interest program as requested.
· Lead the Monthly Status Report (MSR) process and CMS Deliverable requirements and ensure timely, accurate completion and submission.
· Provide training and guidance to Specialists 1 and 2 on the preparation of quarterly board reports for JH and JL contracts. Maintain oversight and responsibility to ensure timely and accurate completion and submission.
· Analyze monitoring results, audit samples , and operational data to identify compliance risks, document trends, and recommend mitigation strategies.
· Identify risks that may affect government contracts and escalate to the compliance officer.
· Support compliance document control process and serve as an alternate document control administrator.

Training (20%)
· Lead the