Compliance Consultant V - Investigations

This senior level individual contributor is primarily responsible for conducting company compliance activities in partnership with internal and external stakeholders. Responsibilities include leading compliance reporting efforts and compliance investigations. Additional key responsibilities include driving the implementation of compliance efforts and regulatory compliance through monitoring and interpreting complex regulatory changes. This individual contributor also manages projects or compliance components of larger cross-functional projects including identifying and managing stakeholders.

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.
• Conducts company compliance activities by partnering with internal and external stakeholders; applying established regulations and standards to compliance efforts; designing, developing, and executing strategic compliance initiatives; analyzing regulations and regulatory changes, and their application to operations; and documenting compliance activities.
• Leads compliance reporting efforts by evaluating and summarizing compliance data, audit information, and potential risks and remedies; identifying and reporting key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations) to management; and developing presentations to convey key findings to management and other key stakeholders.
• Leads compliance investigations by coordinating the collection and analysis of quantitative and qualitative data; leading interviews as appropriate; researching key business issues; identifying potential action steps; and evaluating and recommending corrective action plans for substantiated allegations.
• Manages projects or compliance components of larger cross-functional projects by identifying and managing stakeholder contacts; assembling teams based on project needs and team member strengths; developing, analyzing, and managing project plans; negotiating and managing project schedules and resource forecasts; and managing project financials and deliverables.
• Drives regulatory compliance by monitoring and interpreting complex regulatory changes; leading analysis on regulatory impacts; and overseeing the implementation of designated changes.
• Drives the implementation of compliance efforts by identifying compliance requirements; leading the assessment of current state compliance to identify gaps and corrective actions; creating or revising complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication
• Critical Thinking
• Cross-Group Collaboration
• Decision Making
• Dependability
• Diversity, Equity, and Inclusion Support
• Drives Results
• Facilitation Skills
• Health Care Industry
• Influencing Others
• Integrity
• Learning Agility
• Organizational Savvy
• Problem Solving
• Short- and Long-term Learning & Recall
• Teamwork
• Topic-Specific Communication

• Analytical Skills
• Compliance Management
• Cross Department Coordination
• Getting Work Done Through Others
• Negotiation
• Project Management
• Technical Communication
• Written Communication

• Minimum three (3) years experience in a leadership role with or without direct reports.
• Bachelors degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum eight (8) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.

• Five (5) years medical coding experience.
• Five (5) years experience in privacy and security compliance.