Integrity and Compliance Consultant

HealthPartners is hiring an Integrity and Compliance Consultant. This Consultant position is responsible for the management of external regulatory audits and audit readiness functions for the health plan Medicare and Medicaid products. Key responsibilities include audit management, advising operational leaders on corrective action plan development, proactive risk identification and mitigation activities.

ACCOUNTABILITIES:

Develops, maintains, and promotes HealthPartners Integrity and Compliance program expertise [Be a program builder and ambassador]

• Lead and manage complex projects and initiatives that fall within the assigned program services group
• Provide direction and guidance to analysts, as needed, and support their professional growth
• Lead and support program services group when manager or other leader is unavailable (lead meetings, etc.)
• Promote and execute collaboration within and across program services groups
• Be an ambassador for the Integrity and Compliance Program
• Help establish, know and meet required deadlines

Serve as subject matter expert on compliance issues [Know the rules and the risks, and educate others about them]

• Serve as subject matter expert on program services group
• Serve as primary point of contact for key business partners
• Participate in industry groups, as identified
• Use legal counsel, internal content experts, internal and external resources and trends relating to Compliance activities in developing and maintaining subject matter expertise
• Conduct regulatory, policy, and other research on compliance matters using internal and external resources
• Demonstrate understanding of and ability to articulate seven elements of an effective compliance program
• Develop deep expertise of the work of assigned program services group
• Support operational areas' compliance with applicable laws, regulations and requirements

Identify opportunities and risks; propose, facilitate/support, and implement solutions [Help others make risk-based decisions]

• Proactively build organizational knowledge of the entire HealthPartners system.
• Analyze business challenges that have compliance implications and propose solutions to identified risks and opportunities to department leaders and business partners.
• Identify challenges, barriers and options for assigned projects/initiatives; work with business partners and department leaders to resolve
• Identify, develop, and execute on opportunities for process improvement, innovation and automation within program services group

Communicate effectively [Be clear about it]

• Support and present at Compliance Oversight Committees as needed
• Write SBARs, reports and memoranda to document compliance and business challenges and proposed solutions
• Communicate issues requiring escalation to managers and other leaders with appropriate level of detail

Build and maintain stakeholder partnerships [Build and maintain strong partnerships]

• Be advisor/consultant to business areas and business leaders on compliance-related matters
• Develop relationships with key internal stakeholders
• Support business leaders on compliance matters
• Meet regularly with leaders to understand compliance challenges and issues
• Interact professionally with regulators and other outside officials

Assist with professional growth of analysts. Provide direction to analysts; provide support to manager with regular communication

REQUIRED QUALIFICATIONS:

• Bachelor's degree; or equivalent work experience
• 4-6 years of experience in a healthcare or other highly regulated environment
• Familiarity with reading, analyzing and working with healthcare or other complex laws, regulations and requirements
• Familiarity with Microsoft Office applications, including Power Point, Excel and Visio
• Ability to effectively communicate, both written and oral, with different audiences, and tailor messages accordingly
• Ability to grasp new and complex concepts quickly, identify key impacts and translate for others
• Ability to self-motivate, take initiative and engage in critical thinking
• A drive for proactive and continuous improvement
• System thinking/orientation
• Experience supporting complex projects
• Excellent organizational and time-management skills
• Strong skills in research and information analysis
• Strong commitment to accuracy and attention to detail
• Ability to work in a fast-paced environment, adapt to changing conditions, and meet deadlines
• Ability to work across departments with a collaborative, responsive, respectful approach

PREFERRED QUALIFICATIONS:

• Advanced degree in relevant discipline such as JD, MHA, MPH or MBA
• 5 years of experience in a health care compliance role
• Understanding of billing and reimbursement processes and systems; health financing; health insurance and/or data privacy in the health care environment.

At HealthPartners we believe in the power of good - good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health

As a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.