Senior Compliance Specialist

Cincinnati Children's•Herald, CA

3d•$74,298 - $94,744•Hybrid

About The Position

This role will be on a hybrid work schedule. The Senior Compliance Specialist will independently interpret and analyze federal and state law, institutional policies, procedures, and guidance related to regulated activities. They will assess the impact of regulatory decisions and lead the creation and revision of departmental policies and procedures. The specialist will serve as an institutional expert in corporate compliance, specifically in healthcare fraud, waste, and abuse, working with Compliance Officers and experts across the organization to improve compliance processes. Responsibilities include conducting legal and regulatory research, preparing written documentation, providing education to employees on compliance issues, developing training materials, enhancing audit activities, and staying current with healthcare compliance issues and regulations. The role involves collaborating with various teams and stakeholders, building consensus, and using project management skills to lead initiatives. The specialist will also serve as a subject matter expert for institutional initiatives, conduct investigations related to corporate compliance, and assist with the operation, reporting, and analytics for the Compliance & Integrity Helpline, Conflict of Interest Program, and Exclusion and Sanction Screening Program.

Requirements

Bachelor's degree in a related field and 5+ years of work experience in a related job discipline OR Master's Degree and 3+ years of directly related experience
Certified Healthcare Compliance (CHC) certification required (Within 24 months for outside hire)

Responsibilities

Independently interpret and analyze the concepts and principles of federal and state law, institutional policies/procedures/guidance and professional guidance as it relates to the review and oversight of regulated activities and assess the impact of specific regulatory decision issues on the overall environment at CCHMC.
Lead the creation and revisions of departmental policies/procedures/guidance.
Support, as an institutional corporate compliance expert (specifically healthcare fraud, waste, and abuse), the creation and revision of institutional policies/procedures/guidance.
Serve as an institutional expert in corporate compliance activities (specifically healthcare fraud, waste, and abuse).
Work with institutional Compliance Officers, designated compliance experts in all operational areas to continue to improve compliance processes.
Conduct legal and regulatory research and prepare written documentation such as policies, procedures, and other written communication to support ongoing activities of the Compliance Program.
May independently interpret & analyze the concepts & principles of government regulations & guidance.
Provide education for new and existing employees on compliance issues and the Compliance Program.
Develop training and communication materials.
Enhance and improve audit activities to monitor compliance in identified areas.
Stay current regarding compliance issues and regulations affecting health care and recommend changes as appropriate.
Work collaboratively with various teams and interface effectively with primarily internal and occasionally external stakeholders at primarily peers across the organization.
Build consensus among stakeholders after more senior leaders have established priorities and gain commitment to achieve defined institutional priorities.
Use basic project management and organizational skills to lead divisional/departmental initiatives.
Lead project team to achieve successful outcomes through both direct and indirect leadership.
May lead the development and execution of specific aspects of a regulatory and compliance program in support of the institution's strategic plan.
Contribute to recommendations for solutions that maximize organizational performance.
Represent CCHMC at the regional and national level disseminating best practices.
Serve as a subject matter expert in assigned program area.
May be called upon to provide key input, based on knowledge, experience and expertise, on institutional initiatives and programs at the direction of leadership, in order to ensure compliance with applicable federal and state regulations and statutes and CCHMC policies, principles, ethical standards and procedures.
Conduct investigations related to corporate compliance (specifically healthcare fraud, waste, and abuse).
Follow investigational procedures documenting appropriate information & outcomes.
Collaborate with compliance officers, departments, & managers as needed.
Implement corrective & preventative action.
Assist with operation, reporting, and analytics for the: Compliance & Integrity Helpline, Conflict of Interest Program, and Exclusion and Sanction Screening Program.