[Hiring] Senior Ethics & Compliance Specialist @GuideWell Source

Role Description

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

• 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.
  • 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.
  • Support the Conflict of Interest program as requested.
  • Lead the Monthly Status Report (MSR) process and CMS Deliverable requirements.
  • Provide training and guidance to Specialists 1 and 2 on the preparation of quarterly board reports.
  • Analyze monitoring results, audit samples, and operational data to identify compliance risks.
  • 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 annual review of all compliance training modules and materials.
  • Use training completion data and metrics to assess effectiveness and recommend improvements.
  • Conduct live training, as needed across departments and stakeholders groups.
  • Assist the Compliance Specialists 1 and 2 in preparing training content and coordinating training activities.
  • Identify opportunities to enhance training effectiveness.
• Projects (10%)
  • Leads improvement projects by coordinating activities and drafting project plans.
  • Provide subject matter guidance for Specialists 1 and 2 on project plans.
  • Analyze project outcomes to identify trends, gaps, or opportunities for process improvements.
  • Collaborate with HR, Legal, Information Security, Internal Audit, and operational management on cross-functional compliance initiatives.
  • Draft or refine project materials related to assigned compliance projects.
• Administrative (10%)
  • Lead or facilitate compliance-related meetings.
  • Serve as the alternate Business Continuity Coordinator (BCC) for the Compliance department.
  • Prepare and oversee preparation of compliance documentation.
  • Compile, validate and interpret data for committee reports.
  • Perform other administrative duties to support the compliance officer and the compliance department.

Qualifications

• Bachelor's degree in a related field.
• 3 years related work experience in compliance, auditing, regulatory, healthcare operations, or similar field.
• Demonstrated strong analytical and problem-solving skills.
• Demonstrated effective written and verbal communication skills.
• Demonstrated ability to interact one-on-one, and with all levels of management as well as external parties.
• Demonstrated proficiency using Microsoft Office Products, including Word and Excel.
• Demonstrated team building skills with other team members, management, and external parties.
• Demonstrated ability to maintain confidentiality.
• Demonstrated personal integrity, discretion and good judgement.
• Demonstrated ability to handle challenging conversations.
• Demonstrated ability to navigate conflict.
• Demonstrated relationship-building across departments.
• Demonstrated organization skills.
• Demonstrated ability to prioritize work.
• Demonstrated ability to work efficiently.
• Demonstrated flexibility and ability to adapt with projects and work assignments.

Requirements

• 3 years' related work experience in the Medicare Fee-For-Service field.
• Experience with Medicare Part A and Part B contractual, compliance, and operational guidelines.
• Experience with the Compliance and Integrity Processes, business ethics, corporate policies and procedures.
• Certified Compliance and Ethics Professional (CCEP), Certified Healthcare Compliance (CHC), Certified Compliance Professional (CCP), or a similar certification from a recognized professional organization.

Benefits

• 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.