Sr. Compliance Principal

Responsibilities:

• Strategic Leadership & Program Evolution: Lead and contribute to the development of our goals and principles in creative and effective ways. Apply broad expertise to address significant and unique compliance issues, using conceptual thinking to understand advanced issues and their possible effects. Be an internal subject matter expert, providing expertise on broader organization projects that require an understanding of the wider business.
• Critical Risk Management: Identify and assess significant and unique compliance risks, including those related to regulatory compliance, HIPAA Privacy, billing and coding/revenue cycle, and federal/state health insurance programs. Design and implement long-term risk mitigation strategies, exercising independent judgment in the methods, techniques, and evaluation criteria for obtaining results. Conducting risk assessments and developing corrective action plans.
• Advanced Monitoring and Auditing: Provide strategic guidance and oversight for monitoring and auditing activities, using insights from these findings to inform future program design and long-term preventative measures.
• Expert Guidance & Internal Influence: Serve as the enterprise-wide subject matter expert, conveying advanced information and persuading diverse team members and audiences. Create formal networks involving coordination among various groups to achieve compliance goals. May direct the activities of others.
• Cross-Functional Impact: Work on issues where the analysis of situations or data requires an evaluation of intangibles, with accountability for results that may affect the entire function.

Qualifications:

• Bachelor's degree with 12 years of relevant experience, or a Master's degree with 8 years of experience, or a PhD with 5 years of experience, or equivalent combination of education and experience.
• Extensive knowledge of theories, practices, and design matters related to healthcare compliance.
• Significant experience developing and leading critical, strategic initiatives within a compliance program.
• Experience applying healthcare compliance expertise.
• Experience creating formal networks and coordinate among groups to influence important partners across the organization.
• Experience with conceptual thinking to understand advanced issues and their possible effects.
• Recognized internally as a subject matter expert.
• Deep Regulatory Knowledge: Expert-level understanding of healthcare laws, regulations, and ethical standards, including HIPAA, CCPA, ACA 1557, the False Claims Act, and the Anti-Kickback Statute.
• Audit and Oversight: Experience developing and administering compliance audits and an understanding of data collection, analysis, and reporting mechanisms to monitor compliance efforts.
• The capacity to analyze complex data, interpret regulations, and develop effective solutions to intricate compliance issues.

Preferred Qualifications:

• Expertise in government payor program compliance, such as Medicare, Medicaid, ACA and Tri-Care
• Certification in healthcare compliance (eg. CHC, CCEP) or privacy (eg. CIPP, CIPM).
• AI governance/compliance experience.
• Proficiency with compliance case management systems and platforms.

Physical/Cognitive Requirements:

• Prompt and regular attendance at assigned work location.
• Ability to remain seated in a stationary position for prolonged periods.
• Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, computer, and other office-related equipment.
• No heavy lifting is expected; occasional exertion of about 20 lbs. of force (e.g., lifting a computer or laptop) may be required.
• Ability to interact with leadership, employees, and members in an appropriate and professional manner.
• Some overnight business travel will be required.