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 Associate & Ethics Compliance Spec and Ethics & Compliance Spec 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 Associate Ethics & Compliance Spec and Ethics & Compliance Spec 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 annual review of all compliance training modules and materials, ensuring consistency, and alignment with regulatory requirements and internal policies. · Use training completion data and metrics to assess effectiveness and recommend improvements. · Conduct live training, as needed across departments and stakeholders groups as requested or necessary. · Assist the Compliance Specialists 1 and 2 in preparing training content, facilitating training sessions, and coordinating training activities for compliance officer review · Identify opportunities to enhance training effectiveness, including improvements in content, delivery methods, engagement, and alignment with emerging compliance risks. Projects (10%) · Leads improvement projects by coordinating activities, drafting project plans and timely completion of deliverables. · Provides subject matter guidance for Associate Ethics & Compliance Spec and Ethics & Compliance Spec on project plans, documentation standards, and stakeholder coordination. · Analyze project outcomes to identify trends, gaps, or opportunities for process improvements and present recommendations to the compliance officer. · Collaborate with HR, Legal, Information Security, Internal Audit, and operational management on cross-functional compliance initiatives or multi-departmental projects. · Draft or refine project materials, including communications, summary reports, process documents, and training resources related to assigned compliance projects. Administrative (10%) · Lead or facilitate compliance-related meetings; including Navigator Champion meetings, cross-functional working sessions, and internal compliance meetings, ensuring agendas, materials, and follow-up actions are completed. · Serve as the alternate Business Continuity Coordinator (BCC) for the Compliance department, ensuring requirements are met and documentation is maintained. · Prepare and oversee preparation of compliance documentation, including meeting minutes, reports, dashboards, and regulatory deliverables, ensuring accuracy and timeliness. · Compile, validate and interpret data for committee reports, internal reports and CMS deliverables, ensuring accuracy. · Perform other administrative duties to support the compliance officer and the compliance department, as assigned. Performs other duties as the supervisor may, from time to time, deem necessary. REQUIRED 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 PREFERRED QUALIFICATIONS * 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 and, general understanding of the Office of Inspector General (OIG) and Medicare Fee-For-Service Compliance guidance * Experience with the Compliance and Integrity Processes, business ethics, corporate policies and procedures, evaluating conflict of interest, preparing and conducting compliance and conflict of interest training * Certified Compliance and Ethics Professional (CCEP), Certified Healthcare Compliance (CHC), Certified Compliance Professional (CCP), or a similar certification from a recognized professional organization. The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive. Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment. Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards. "We are an Equal Opportunity/Protected Veteran/Disabled Employer." This opportunity is open to remote work in the following approved states: AL, AR, FL, GA, ID, IN, IO, KS, KY, LA, MS, NE, NC, ND, OH, PA, SC, TN, TX, UT, WV, WI, WY. Specific counties and cities within these states may require further approval. In FL and PA in-office and hybrid work may also be available.