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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Attorney
Health Care
Litigation - Whistleblower - CFTC
Min 8 yrs required
Internal Audit Director Healthcare Sector Duties: Leveraging industry and technical expertise to assist management to address more effectively risks associated with their business. Assisting management in the assessment of project risks and controls. Enhancing internal audit functions to further align to company strategy and risk. Reducing company costs through strategic internal audit outsourcing and co-sourcing solutions. Increasing value and reducing costs of compliance-related activities. Identifying opportunities for companies to effectively mitigate risk and improve business performance. Applying the concepts of Enterprise Risk Management to help companies identify, assess, mitigate and proactively consider emerging risks PwC's Healthcare Compliance (HCC) team offers an integrated solution which includes:. Framework focusing on key risk areas. Diagnostic for evaluating healthcare compliance program effectiveness and potential gaps. Accelerators for constructing and enhancing all elements of an effective healthcare compliance program. Methodology to optimize, transform, and sustain an effective healthcare compliance program. PwC developed SMART tool for operational monitoring and auditing. Partnerships with industry leading companies including leading GRC tool providers Members of the HCC team help both payer and provider clients assess, design and develop solutions that allow them to manage diverse risks through a consistent, coordinated, and sustainable strategy. PwC's approach is a principles-guided, scalable method that integrates healthcare compliance activities into a manageable and sustainable process. HCC payer and provider services include:. Assessing, improving and streamlining healthcare compliance programs. Identifying compliance risks. Developing annual healthcare compliance auditing and monitoring plans. Developing healthcare compliance training programs. Assessing and recommending effective healthcare compliance communication and committee structures and programs. Improving the content, quality and timing of healthcare compliance analysis and reporting. Implementing a proactive approach to overall risk management. Establishing consistent policies and standards. Leveraging technology to aggregate controls, risk and healthcare compliance information to rapidly identify and report exceptions, and improve information quality. Conducting Compliance Risk Assessments and Compliance Reviews. Providing strategy and consulting for HIPAA, Medicare, Medicaid and other regulatory compliance, etc.
Qualification and Experience
Requirements: Bachelor's degree in Business Administration or business-related field. J.D. Degree or Master's degree in Business, Accounting or Healthcare-related field preferred. 8 years of Healthcare-related compliance experience, including consulting, risk management or operational roles. Prefer CHC, CHPC or CCEP. Proven expertise and success managing the implementation of an Ethics and Compliance program within the healthcare industries, including the following: Federal Sentencing Guidelines and OIG guidance, healthcare-related laws, regulations (e.g., HIPAA, Medicare, Medicaid, Anti-Kickback, Fraud and Abuse laws, False Claims Act) and regulatory agencies to implement and monitor changes to Federal and State healthcare compliance program requirements, including systems, processes, policies and procedures. Advisement to executive leaders and Boards of Directors on healthcare compliance and ethics matters, including designed healthcare compliance controls recommendations. Conduct of healthcare compliance program effectiveness reviews--leading and developing auditing and monitoring programs to address identified compliance risks; overseeing the implementation of corrective actions and monitoring responses to identified compliance issues and audits; and, conducting healthcare compliance risk assessments, leveraging enterprise databases that include advanced data analytics and management reporting. Oversight, development and conduct of healthcare compliance education and training programs. Extensive knowledge of fraud and abuse prevention programs, compliance hotline protocols, and compliance investigation process and procedure. Demonstrated proven expert-level abilities and success to lead teams and client engagements related to directing and implementing ethics and compliance programs within the healthcare industries, including the following: Leading and managing business development opportunities and/or engagements from pre-sale and initial scoping through final delivery and signoff; Utilizing consistent creative problem-solving abilities and consultancy mindsets while working on, as well as researching problems and/or issues and developing effective solutions for, clients' healthcare compliance activities; Identifying and addressing client needs: build solid relationships with clients; develop an awareness of Firm services; approach client in an organized and knowledgeable manner; deliver clear requests for information; demonstrate flexibility in prioritizing and completing tasks; Maintaining relationships and building credibility with key executives, companies, and a network of professional organizations or affiliations within healthcare, ethics and compliance; Conducting analyses that leverage creative and critical thinking and problem solving, as well as advise on and derive solutions through, utilizing information systems, databases, Excel and Microsoft Word; Developing strategy; as well as writing, communicating, facilitating, and presenting cogently; to and/or for all levels of industry audiences, clients and internal staff and management; Budgeting and forecasting on large engagements; Leading teams: supervising teams to create an atmosphere of trust; seeking diverse views to encourage improvement and innovation; participating in various staff recruitment and retention activities; and coaching staff including providing timely meaningful written and verbal feedback; and demonstrating flexibility and desire to travel, as client assignments require. Demonstrates prior success in business development and conduct of internal audits within a professional services environment, emphasizing clinical, legal, auditing or other compliance areas.
Job ID: 69307BR-0
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