Advisor Enterprise Compliance

Job Summary

The Advisor Enterprise Compliance supports the implementation and maintenance of key elements of the organization’s compliance framework. This position is responsible for overseeing the development and review of organizational policies and procedures, administering the governance, risk, and compliance (GRC) system, and supporting compliance reporting activities.

The Advisor ensures compliance processes are executed effectively, including managing the exclusion monitoring process and coordinating activities related to the ethics hotline and civil rights mailbox. This position contributes to the compliance program.

The Advisor also supports research and evaluation of initiatives aimed at strengthening compliance program effectiveness and operational efficiency.

This position collaborates with key stakeholders to review programs, projects, processes, procedures, and policies; and conduct end-to-end root cause analysis to enhance and improve outcomes and remediate issues to comply with the national and statewide standards and regulations.

Provides expert advice to various teams, including program and product development, marketing, and customer service, on various relevant topics.

Duties

Policy and Procedure Management

Draft, review, and maintain organizational policies and procedures in alignment with regulatory and contractual requirements.

Manage the policy and procedure module within the GRC system, ensuring documents are current and accessible.

Support operational execution of policy lifecycle processes and related documentation.

GRC System Administration

Administer the enterprise GRC platform, ensuring accurate configuration, timely updates, and effective user support.

Monitor system performance and coordinate enhancements or troubleshooting as needed.

Compliance Training Support

Coordinate and monitor required compliance training assignments for employees and Board of Governors.

Track completion and escalate noncompliance as needed.

Support content review and system reporting.

Exclusion Monitoring

Conduct and document exclusion monitoring activities in alignment with regulatory requirements.

Prepare reports on monitoring outcomes and escalate issues as appropriate.

Ethics Hotline and Civil Rights Mailbox

Oversee intake and tracking of ethics and civil rights concerns submitted through hotline and mailbox channels.

Coordinate documentation, triage, and follow-up processes to ensure timely resolution.

Maintain accurate records and prepare summary reporting.

Duties Continued

Compliance Reporting

Support the preparation of compliance reports and dashboards for key stakeholders.

Provide timely and accurate data for reporting on compliance program operations and outcomes.=

Compliance Program Support and Initiatives

Conduct research and contribute to recommendations for program enhancements.

Support project planning and execution of compliance improvement initiatives.

Assist in documenting processes and implementing new tools or approaches.

Develop reports, analyze data and provide presentation on status of areas of responsibilities on an as needed basis in support of department operations.

Partner with the management to communicate compliance and operational priorities and provide feedback or follow-ups to key stakeholders.

Act as the point of contact for key strategic initiatives. 

Provide expert advice to various business units on relevant topics within the organizational standards, national and state-wide compliance.

Conduct research and analysis of business performance and improvements with key stakeholders to document current state, identify gaps and present remediation plan/options to leadership.  Lead the implementation of initiatives and monitor for successful outcomes.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:

At least 5 years of experience in designing, implementing, or monitoring regulatory requirements, policies, or practices in a healthcare or related setting.

Preferred:

Experience with governance, risk, and compliance (GRC) systems.

Experience in data analysis, understanding payment rates, and managing healthcare costs.

Skills

Required:

Strong organizational and planning skills.

Ability to handle multiple assignments, changing priorities, and competing deadlines.

Solid understanding of regulatory compliance guidelines and policies.

Strong verbal, written communication, and presentation skills.

Strong analytical and problem-solving skills.

Ability to work collaboratively with cross-functional teams.

Ability to clearly and effectively convey information.

Ability to analyze complex situations, data, and information to identify issues and develop effective solutions.

Ability in building and maintaining strong, trusting relationships with stakeholders.

Ability to adjust to changing trends, industries, and client needs.

Possess extensive, specialized knowledge in their field.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Additional Information