Compliance Operations Specialist

Corewell Health • Grand Rapids, MI

2d • Hybrid

About The Position

This is a hybrid position that requires onsite presence two days per week at either CHW, CHE, or CHS. Join Corewell Health as a Compliance Operations Specialist, where you will play a key role in supporting and advancing our compliance operations across the organization. In this dynamic position, you will help administer policy management, deliver compliance education, and provide expert guidance to a diverse range of stakeholders. The ideal candidate is a detail-oriented problem solver with strong customer service skills, capable of navigating complex challenges and collaborating with teams to drive operational excellence and uphold regulatory standards. Job Summary Responsible for developing, and implementing, compliance operations programs and functions that address strategic and operational goals of the Corewell Health Compliance department. Responsible for supporting projects and operational initiatives over the entire project lifecycle to ensure timely completion with general supervision. Maintains knowledge of relevant state and federal statutory requirements and local policy standards. Conducts periodic educational programs to respond to departmental/organizational needs. The Compliance Operations Analyst will partner and collaborate across Compliance teams and engage with customer stakeholders from Corewell Health Corporate, East, South, West and Priority Health in creating and developing programs and work products that support the strategies, initiatives and goals of the organization. Essential Functions Assesses resource requirements for project tasks and works with leaders of functional areas and subject matter experts to meet project plan deliverables. Supports the development, implementation and performance of the Compliance Operations program which oversees the tools and processes that support compliance operations (example, Annual Education, Conflict of Interest, Policy Management, Sanction Screening, Regulatory Review, etc.) Supports risk assessment, annual work plan, and compliance education activities and initiatives. Assists in the development of standard work and other departmental policies and procedures specific to assigned program area. Participates in evaluation, implementation, and maintenance of vendor software solutions or platforms and assists with managing vendor relationships. Supports compliance investigations; performs necessary research, documents findings, and follows up with applicable parties through complete resolution. Collects, collates, monitors and audits data and activities to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse. Works with outside consultants or external regulatory agencies in performing audits as necessary at the direction of management. From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of such investigation to provide guidance, recommendations and other assistance as requested by legal counsel. In such cases, the employee will report directly to legal counsel as opposed to employee’s up-line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection. Build/design training materials for team members in a variety of venues and service areas with respect to compliance regulations, requirements, and initiatives. Maintains knowledge of laws and regulations impacting health care and health insurance delivery and reimbursement. Applies laws and regulations in daily situations while educating others through various means including formal training and annual compliance related education programs. Performs related assessments to assure compliance. Performs or supports the performance of related assessments to assure compliance to laws, regulations and policies and procedures. Assists in the compilation and production of reports to Board and Compliance Committees.

Requirements

• Bachelor's Degree or equivalent in business, health care operations, nursing or other related area
• 3 years of progressively responsible related work experience

Nice To Haves

• Master's Degree or equivalent in business, health care operations, nursing or other related area
• Health care operations, auditing and/or compliance
• Legal or regulatory field; healthcare focus desirable
• 1 year of project management/program development and implementation
• CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association within 1 year after hire

Responsibilities

• Assesses resource requirements for project tasks and works with leaders of functional areas and subject matter experts to meet project plan deliverables.
• Supports the development, implementation and performance of the Compliance Operations program which oversees the tools and processes that support compliance operations (example, Annual Education, Conflict of Interest, Policy Management, Sanction Screening, Regulatory Review, etc.)
• Supports risk assessment, annual work plan, and compliance education activities and initiatives.
• Assists in the development of standard work and other departmental policies and procedures specific to assigned program area.
• Participates in evaluation, implementation, and maintenance of vendor software solutions or platforms and assists with managing vendor relationships.
• Supports compliance investigations; performs necessary research, documents findings, and follows up with applicable parties through complete resolution.
• Collects, collates, monitors and audits data and activities to assure accuracy and to prevent, detect and correct non-compliance, illegal activities, and potential or actual fraud, waste or abuse.
• Works with outside consultants or external regulatory agencies in performing audits as necessary at the direction of management.
• From time to time, performs investigations at the direction of legal counsel and works with legal counsel in the course of such investigation to provide guidance, recommendations and other assistance as requested by legal counsel. In such cases, the employee will report directly to legal counsel as opposed to employee’s up-line leadership, and such work with legal counsel shall be confidential and protected from disclosure by the attorney client privilege and work product protection.
• Build/design training materials for team members in a variety of venues and service areas with respect to compliance regulations, requirements, and initiatives.
• Maintains knowledge of laws and regulations impacting health care and health insurance delivery and reimbursement.
• Applies laws and regulations in daily situations while educating others through various means including formal training and annual compliance related education programs.
• Performs related assessments to assure compliance.
• Performs or supports the performance of related assessments to assure compliance to laws, regulations and policies and procedures.
• Assists in the compilation and production of reports to Board and Compliance Committees.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• Learn more here.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance, pet insurance
• Traditional and Roth retirement options with service contribution and match savings
• Eligibility for benefits is determined by employment type and status

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees