Risk Assurance Health Care Compliance Director
PwC/LOS OverviewPwC is a network of firms committed to delivering quality in assurance, tax and advisory services.We help resolve complex issues for our clients and identify opportunities. Learn more about us at www.pwc.com/us.At PwC, we develop leaders at all levels. The distinctive leadership framework we call the PwC Professional ( provides our people with a road map to grow their skills and build their careers. Our approach to ongoing development shapes employees into leaders, no matter the role or job title.Are you ready to build a career in a rapidly changing world? Developing as a PwC Professional means that you will be ready- to create and capture opportunities to advance your career and fulfill your potential. To learn more, visit us at www.pwc.com/careers.What will you do if you work in Assurance at PwC?You'll ask questions and test assumptions. You'll help determine if companies are reporting information that investors and others can rely on. You'll help businesses solve complex issues faced by management and boards. You'll serve the public interest and the capital markets by conducting quality audits. Visit for more information on PwC's Assurance practice.The world is quickly changing, that's why PwC is quickly adapting. We're capitalizing on trends that will impact corporate reporting.Our focus is on globalization, technology, sustainability and environmental reporting, population shifts and regulation. We combine skills and experience to help our clients address their challenges.Job DescriptionBoards of Directors and executive management recognize the ever increasing importance of effective risk management efforts in meeting their organization's strategic objectives.PwC's Risk Assurance practice has developed a holistic approach to risk that protects businesses, facilitates strategic decision making and enhances efficiency. Our holistic approach is complimented by the extensive risk and controls technical knowledge and sector-specific experience our Risk Assurance professionals possess.The end result is a risk solution that is tailored to meet the unique needs of a company.Areas where our Risk Assurance practice can bring value to an organization include:- 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 risksPwC'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.Position/Program RequirementsMinimum Year(s) of Experience: 6 years of Healthcare-related compliance experience, including consulting, risk management or operational rolesMinimum Degree Required: Bachelor's degree in Accounting, Finance/Economics, Management Information Systems, Computer Science, Business Administration, Statistics Mathematics, Regulatory Compliance, Science, Technology, Engineering & Mathematics and/or other business fields of studyDegree Preferred: Juris Doctorate or Master's degree in Business, Accounting or Healthcare-related fieldCertification(s) Preferred: CHC, CHPC or CCEP Knowledge Preferred:Demonstrates proven expertise and success managing the implementation of an Ethics and Compliance program within healthcare industries, including:-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 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 procedureSkills Preferred: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:-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;-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 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.
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