Primary focus areas:
- Manage a comprehensive healthcare compliance strategy aligned with Sagility's growth objectives and risk tolerance, with a deep understanding of the healthcare regulatory landscape of the United States.
- Provide oversight of the risk-assessment process, ensuring the process is effective, collaborative, and includes the voice of the customer, regardless of location.
- Recognize and address the interconnection of compliance risks between the lines of business, regions, affiliates, and systems and ensure the compliance risks are prioritized and integrated into risk plan development.
- Work with multiple leadership teams to align compliance efforts with Sagility's mission, values, and overall strategic direction.
- The Vice President of Global Compliance is responsible for ongoing compliance monitoring within the purview of the Sagility Code of Conduct, and its policies, procedures and client obligations.
- Enable, and develop a global compliance team to successfully lead periodic compliance audits in coordination with the audit department, operations, and other cross-functional teams in multiple global locations.
- Lead and manage the compliance teams within each operational geography and collaboratively work with multiple compliance personnel to enforce compliance related laws, regulations, contractual requirements, procedures, audits and other initiatives relevant to Sagility and its clients.
- Conduct regular assessments to identify compliance risks and vulnerabilities; develop and implement solutions to such risks and vulnerabilities; and audit and monitor solutions to risks and vulnerabilities post-implementation.
- Stay updated with evolving best practices, and governmental requirements relevant to all services delivery locations; interpret and communicate compliance requirements to stakeholders across the organization utilizing multiple communication channels.
- Maintain compliance documents and up-to-date compliance reports and records as required and necessary.
- Foster a culture of compliance awareness and accountability throughout the organization by delivering compliance-training programs to educate the Board, employees, vendors, and contractors.
- Lead compliance investigations and fact-finding efforts to ensure non-compliance issues are addressed and action taken combined with root cause analysis to evaluate and resolve systemic weakness.
Essential Position Competencies and Requirements:
- Ability and confidence to successfully work with clients, including enterprise leaders and outside regulators, managers, and frontline employees in multiple locations.
- Ability to multitask on various projects, working with multiple deadlines and workgroups.
- Excellent project management skills with ability to create and meet time budgets and project deadlines.
- Ability to negotiate successful outcomes with strong problem-solving, conflict-resolution, and negotiation skills.
- Demonstrated analytical skills.
- Organizational and problem-solving skills, with the ability to identify and achieve desired goals.
- Ability to understand and interpret complex legal documents, state and federal regulations, and contracts.
- Working knowledge and operations of Microsoft Office products.
- Orient to customer and team needs and expectations.
- Demonstrate subject matter expertise in compliance risk areas.
- Remain current with external events, i.e., legislation, trends, and litigation.
- Demonstrate creativity in problem solving, communications, and marketing.
- Ability to recruit, train, retain, lead, inspire, and motivate a diverse professional staff.
- Able to delegate tasks and prioritize projects, and willingness to effectively address difficult situations.
Experience and background
- Legal background with an excellent understanding of the healthcare regulations and laws of the US and of all operational locations.
- Previous Corporate Compliance Officer experience in the healthcare industry.
- Post Qualification work experience of20 + years in an operational ecosystem including extensive compliance and regulatory experience within the US Medicare and Medicaid markets.
- Relevant compliance related certifications would be an added advantage such as Certified in Healthcare Compliance (CHC), Certified in Healthcare Privacy Compliance (CHPC), Chief Privacy and Compliance Officer (CPCO)
- Extensive knowledge of healthcare compliance laws, regulations, and standards applicable to healthcare BPO companies operating in the commercial, Medicare and Medicaid space, including those addressing anti-corruption and anti-bribery, privacy, ARRA, HITECH, HIT-1, Prior Authorization, HIPAA and Healthcare Assessments, Medicare and Medicaid audits and assessments, URAC, NCQA accreditation in Utilization Management, Population Health Management, Health Plan and Medical Centered Medical Homes for example.
- Proven track record of developing and implementing successful compliance strategies in alignment with CMS, OIG and ISO.
- Excellent leadership, communication, and interpersonal skills to successfully collaborate with and influence internal stakeholders.
- Ability to apply a risk-based analysis to compliance issues and demonstrate creativity and flexibility in developing solutions that satisfy both business requirements and legal obligations.
- Strong problem-solving and decision-making abilities.
- Good understanding of technology and operating systems within the healthcare industry for claims processing and backend office functions.
