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CenterWell Senior Primary Care (PCO) is a growing provider organization that currently operates about 340+ senior focused primary care centers in 15 states. The Regulatory Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This team ensures that healthcare providers align their operational practices with legal requirements while fostering collaborative relationships with business partners to uphold ethical standards and mitigate risks.

The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental requirements for clinics across both federal and state requirements. The work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. 

As the Senior Clinical Compliance Professional, you will develop and/or evaluate compliance policies and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic operations, billing, investigations, and processes. Coordinates site visits for regulators, coordinates implementation and compliance with corrective action plans, as needed. You will participate in all phases of the audit process including evaluating control design and adequacy, testing to ensure adherence with established policies and internal controls, and communicating issues and recommendations to management. Coordinates implementation and compliance with corrective action plans. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.

In this role, you will serve as a regulatory compliance subject matter expert with the 2nd line of defense compliance function. Research compliance related issues and communicate those requirements to high level business leaders within the PCO. 

Key Responsibilities:

• Assesses the compliance risks to PCO and leverages the assessment to design the auditing and monitoring activities included in the workplan.  

• Executes assigned portions of the PCO compliance workplan throughout the year.

• Regularly conducts compliance related audits to assess internal controls, examining healthcare records and processes, and analyzing and reporting risks.

• Influence department strategy by identifying and overseeing the development of continuous monitoring activities.

• Provide reporting on metrics and M&A activity related to revenue cycle management.

Use your skills to make an impact
 

Required Qualifications

• Bachelor's degree

• 3 or more years of healthcare experience in revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims)

• Experience with Auditing and monitoring of healthcare records

• Must be able to work core business hours on EST time between (9am-5pm).

• Willingness to travel up to 10% to conduct audits at site locations.

• Ability to manage multiple or competing priorities and meet deadlines

• Must be passionate about contributing to an organization focused on continuously improving consumer experiences

• Effective verbal and written communication skills

• Strong attention to detail

• Ability to articulate findings and impacts

• Knowledge/understanding of laws and regulations governed by the Department of Insurance and CMS

Preferred Qualifications

• Compliance regulations knowledge and compliance auditing experience

• Ability to analyze large data sets

• Knowledge of healthcare compliance, mainly primary care and risk adjustment, pharmacy knowledge a plus

• Certified Coder (CPC, CRC, and/or CMC)

• Experience with metrics and reporting

Additional Information

Work-At-Home Requirements:

To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:

• At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

• Satellite, cellular and microwave connection can be used only if approved by leadership.

• Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-w