Located in Denver, this position is responsible for supporting the Company’s successful execution of their compliance auditing and monitoring program. The Compliance Auditing and Monitoring Manager serves as a subject matter specialist who provides support directly or indirectly to multiple operational stakeholders, legal counsel, and compliance professionals across the organization. As a Manager, you will join a team of highly motivated individuals and will be a key player in enhancing compliance oversight.
The position encompasses multiple functional areas related to Compliance, including:
- Completing risk assessments;
- Planning and developing monitoring programs;
- Conducting monitoring and audits;
- Documenting findings;
- Recommending and implementing corrective action plans;
- Coordinating external audit requests from payors;
- Coordinating internal audit requests; and
- Designing processes and controls in partnership with Operations.
This role may also support other key parts of the compliance program, including day-to-day support of the company's commercial and government comprehensive care business lines, and other compliance-related activities. For example, the role may also occasionally support the development of policies and procedures, and the creation and implementation of training programs, among other activities. As a Manager, the role would require the ability to:
- Effectively communicate across various departments both internally and externally,
- Understand new contractual arrangements,
- Support development of new and existing business processes,
- Manage competing priorities related to healthcare compliance and CMS regulations across the company's commercial and government programs,
- Analyze and interpret operations data to support to organizational efforts to improve the efficiency and effectiveness of these areas, and
- Summarize and report data to Compliance and Operations management teams.
The Manager will be expected to have the ability to obtain and leverage a thorough understanding of business processes and supporting technology infrastructure to re-design and improve existing business processes.
- Reports to a Senior Compliance Manager;
- Identifies and assesses areas of compliance risk; documents findings and recommendations; and drives development and monitors completion of corrective action plans;
- Partners and collaborates with operational leadership and legal counsel to develop compliance infrastructure and guidance on all new and current initiatives, including development of monitoring strategies to comply with compliance contract requirements, training and fielding, and responding to day-to-day compliance policy questions;
- Manage competing priorities related to healthcare compliance and CMS regulations across the company's commercial and government programs;
- Responsible for the development of policies and procedures, creation and implementation of training program(s), conducting risk assessments, monitoring corrective action plans, and development of audit and monitoring plans;
- Responsible for developing strong relationships throughout the organization to foster an advisory or collaborative approach to proactive compliance;
- Responsible for identifying system or process improvements that increase efficiency, compliance or reduce cost to the business;
- Makes recommendations to compliance leadership, develops and executes plans to implement recommendations in conjunction with compliance management;
- Demonstrates an aptitude for critical thinking in complex situations and an ability to synthesize ambiguous data into concrete insights;
- Responds to, or oversees responses to, compliance-related inquiries; and
- Other duties as assigned.
- Travel required: Minimal
- Bachelor’s degree required; CPA/CIA/CHC or other relevant advanced degree or certifications a plus;
- 4+ years in reputable accounting or management consulting firm a strong plus, Big 4 Public Accounting Firm experience preferred;
- Preferred minimum of 2+ years’ experience as an audit or compliance professional responsible for the development and implementation of risk assessments and monitoring and/or audit programs;
- Preferred 1-2 years’ experience in healthcare or pharmaceutical industries dealing with federal healthcare program laws including, but not limited to Anti-Kickback Statute, False Claims Act and Civil Monetary Penalty Law;
- Preferred working knowledge of Medicare Part A and B, Accountable Care Organizations (and associated contractual arrangements), Medicare reimbursement methodologies, health insurance operations, coding (ICD-10 and HCC), and claims processing;
- Preferred working knowledge of OIG’s guidance on the basic elements of an effective compliance program;
- Strong organizational and project management skills with demonstrated attention to detail;
- Advanced technology skills including Excel and PowerPoint; experience creating data analytics strongly preferred;
- A thoughtful, articulate, and effective communicator who can distill and articulate the important aspects of any issue to a wide audience of participants;
- Strong written and verbal communication skills, and the ability to drive execution in a team environment;
- Demonstrated management-level presentation experience, including comfort liaising with senior leadership throughout the business;
- Demonstrated experience in implementing major process improvement/redesign, organization change, or transformation programs within a large organization is required;
- Confident and persuasive in presenting and visualizing findings and data driven insights to a wide audience (of varying degrees of management, business functions);
- Must be a self-motivated team player with proven ability to identify issues and manage priorities in a fast paced environment while striving for practical business solutions; and
- Hands on, efficient and proven ability to “Get Stuff Done” with a bias for action and a strong sense of ownership.
- Must be comfortable with and enjoy working in a dynamic space that is constantly evolving, presenting new challenges without clear precedent.