IT Consultant V, Governance Risk and Compliance

About the role

This senior consulting role supports enterprise compliance modernization initiatives that include revenue cycle compliance, revenue integrity, risk adjustment oversight, internal audit, and regulatory change management functions. The position is responsible for selecting and implementing technology platforms and capabilities that support claims audit management, analytics, provider and coder oversight, and continuous compliance monitoring. This role also partners with business and technology stakeholders to design scalable compliance operating models that improve regulatory responsiveness, process efficiency, and organizational transparency to strengthen compliance oversight. This senior level individual contributor is primarily responsible for serving as the lead technical expert on project teams, contributing to technical direction for varying technical solutions, and ensuring IT systems are effectively utilized.

Responsibilities

• Conducts or oversees business-specific projects by applying deep expertise in subject area
• Promotes adherence to all procedures and policies
• Develops work plans to meet business priorities and deadlines
• Determines and carries out processes and methodologies
• Coordinates and delegates resources to accomplish organizational goals
• Partners internally and externally to make effective business decisions
• Solves complex problems
• Escalates issues or risks, as appropriate
• Monitors progress and results
• Recognizes and capitalizes on improvement opportunities
• Evaluates recommendations made
• Influences the completion of project tasks by others
• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders
• Communicates information and provides advice to drive projects forward
• Influences team members within assigned unit
• Listens and responds to, seeks, and addresses performance feedback
• Adapts to competing demands and new responsibilities
• Provides feedback to others, including upward feedback to leadership and mentoring junior team members
• Creates and executes plans to capitalize on strengths and improve opportunity areas
• Adapts to and learns from change, difficulties, and feedback
• Develops requirements, or leads a team of IT consultants in the development of requirements for complex or specialized process or system solutions which may span multiple business domains by partnering with stakeholders and appropriate IT teams (for example, Solutions Delivery, Infrastructure, Enterprise Architecture)
• Leverages multiple business requirements gathering methodologies to identify business, functional, and non-functional requirements (for example, SMART) across the enterprise
• Leads and oversees the development and documentation of comprehensive business cases to assess the costs, benefits, ROI, and Total Cost of Ownership (TCO) of complex solution proposals
• Provides insight, guidance, and recommendations throughout the evolution of applications, systems, and/or processes to a desired future state by maintaining and leveraging a comprehensive understanding of how current processes impact business operations across the enterprise
• Maps current state against future state processes
• Defines the impact of requirements on upstream and downstream solution components
• Provides insight and influence to senior management and business leaders on how to integrate requirements with current systems and business processes across the enterprise
• Reviews, evaluates, and prioritizes value gaps and opportunities for process enhancements or efficiencies
• Influences solution design by providing insight and consultation at design sessions with IT teams to help translate requirements into workable business solutions
• Recommends and advocates for additional data and/or services needed to address key business issues related to process or solutions design
• Participates in evaluating third-party vendors as directed
• Drives continuous process improvement by leading the development, implementation, and maintenance of standardized tools, templates, and processes across the enterprise
• Recommends and advocates for regional and national process improvements which align with sustainable best practices, and the strategic and tactical goals of the business

Qualifications

• Minimum Qualifications: Bachelor's degree in Business Administration, Computer Science, CIS or related field and minimum eight (8) years experience in IT consulting, business analysis, or a related field. Additional equivalent work experience may be substituted for the degree requirement.
• Preferred Qualifications: Four (4) years experience working for a health care organization. Four (4) years experience working for an IT organization.

Skills

• Ambiguity/Uncertainty Management
• Attention to Detail
• Business Knowledge
• Communication