Compliance Liaison Specialist Senior Quality, Stars, & Pharmacy Compliance

Hybrid

Grand Rapids, MI

Full time

R225346

Job Summary

This Compliance Liaison Specialist Senior position serves as the primary compliance partner supporting Quality, Medicare Stars, and Pharmacy operations. The role provides guidance on regulatory requirements, monitoring and auditing activities, investigations, corrective action plans, and compliance education while partnering closely with operational leaders to promote regulatory adherence and program effectiveness.

Responsible for creating, facilitating and maintaining positive relationships between client groups and the Compliance department to support and sustain an effective compliance program. With limited supervision, acts as a resource to leaders/team members regarding policy and regulatory issues, monitoring and auditing activities, corrective action guidance, and education assistance. Provides ongoing consultations to support leaders with day-to-day compliance. Lead projects and facilitates collaboration with additional compliance functional areas as needed.

Essential Functions

• Establishes and maintains effective, collaborative working relationships with delegated client groups including but not limited to team members, leaders, and executives. Provides exceptional customer service; facilitates effective communications to promote team member and leadership engagement. With minimal oversight, deploys systematic processes and partners with the Compliance Centers of Expertise (COEs) as needed in the development and deployment of projects and initiatives.

• Collaborates with leaders in building a strong culture of accountability; works with leaders to resolve most routine situations and develops recommendations for appropriate follow up action. Collaborates with the Compliance COEs as needed to ensure consistency in daily practice.

• Coordinates, advises, and partners with organizational departments on matters relating to various regulatory agency compliance initiatives and regulations.

• Leads or supports audits and investigations of compliance help line calls, privacy incidents, employee complaints, or other compliance contacts or reports. Leads 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. From time to time, performs investigations at the direction of legal counsel following appropriate attorney-client privilege guidelines.

• Maintains expert knowledge of laws and regulations impacting health care delivery and coverage. Applies laws and regulations in daily situations while educating others through various means including formal training. Leads related assessments to assure compliance. Leads or supports the performance of related assessments to assure compliance to laws, regulations and policies and procedures.

• Leads or provides support to operational compliance committees.

• Works with operational leaders and Compliance COEs to develop and monitor internal controls including corrective action in response to investigations and audits to detect and/or prevent illegal, unethical, or improper conduct by team members, agents, affiliated providers or others within the health system.

Qualifications

Required

• Bachelor's Degree or equivalent Business, health care operations, nursing or other related area.

• 5 years of relevant experience Skills, knowledge, abilities typically gained through 5+ years of related experience; health care operations and/or compliance experience desired

Preferred

• Education of clinical and non-clinical staff including Medical Staff and mid-level providers.

• Conducting investigations, performing interviews and summarizing results and findings.

• CRT-Healthcare Compliance, Certified (CHC) - HCCA Health Care Compliance Association Org Integrity and Compliance 1 Year Or

• CRT-Professional Coder - AAPC American Academy of Professional Coders 1 Year Or

• CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association 1 Year Or

• CRT-Fraud Examiner (CFE) - ACFE Association of Certified Fraud Examiners 1 Year Or

• CRT-Internal Auditor, Certified (CIA) - Institute of Internal Auditors Institute of Internal Auditors 1 Year Or

• CRT-IRB Professional, Certified (CIP) - 1 Year preferred Or

• CRT-Healthcare Privacy Compliance, Certified (CHPC) -1 Year Or

• CRT-Healthcare Research Compliance, Certified (CHRC) - CCB Compliance Certified Board 1 Year Or

• CRT-Healthcare Research Compliance, Certified (CHRC) - HCCA Health Care Compliance Association 1 Year

About Corewell Health

As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here (https://careers.corewellhealth.org/us/en/benefits-new) .

• 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

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Priority Health - 1231 E Beltline Ave NE - Grand Rapids

Department Name

System Compliance - Corporate

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency. Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.