The Compliance Specialist assists in the maintenance of the NH Compliance program and policies; participates in special projects, and assists in developing and implementing compliance auditing and monitoring activities, including performing investigations, audits and analysis. The NH Compliance program measures and monitors compliance with laws, regulations and rules for operating in health care with providers, Health Plans, and the government.
The following are the primary responsibilities of this position:
Acts as the Systems Administrator and in-house expert for compliance software platform (Compliance 360)
Monitors compliance-related events and patient complaints (BPCI & MA)
Management/day-to-day operations and maintenance of the Compliance 360 platform
Works closely with internal teams/business units to design workflows
Maintains company-wide policies and procedures
Develops and provides reports from system to appropriate oversight committees
Develops work instructions and trains staff on system use
Manages all Compliance Department documentation including but not limited to Bundled Payment Care Improvement (BPCI) committee charters, confidentiality agreements and annual attestations.
Assists in the documentation, evaluation and validation of regulatory compliance with applicable requirements and guidelines.
Participates in compliance audits to ensure management ability to perform and manage in accordance with applicable regulatory and NH standards, policies, and procedures.
Assists in the monitoring of state and federal regulations & legislation applicable to the NH operations.
Assists in the development and implementation of compliance measures corresponding to professional standards of conduct, as well as applicable federal, state and local laws.
Assists and in some instances performs follow-up of compliance audits and monitoring activities to ensure that management’s action plans are properly implemented in a timely manner.
Assists and in some instances prepares clear and concise reports of the compliance audits and monitoring activities including valuation of risk, root cause and scope of impact of the findings.
Assists in monitoring changes in state and federal laws and regulations to ensure organizational compliance.
Assists in researching, investigating and analyzing compliance and privacy issues when rendering professional advice to operational areas and senior management.
Exhibits excellent oral and written communication skills. This includes the ability to share information in an organized, clear and timely manner, both verbally and in writing; keeping peers, staff and compliance staff informed.
Additional duties: This job description reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as the complete description of all the work requirements and expectations inherent to this position. NH Management reserves the right to assign additional duties as necessary to accomplish NH goals.
Minimum of a bachelor’s degree required or healthcare work experience in an MA plan with progresive responsibilities.
At least 2 – 3 years of related healthcare compliance and/or audit experience.
Excellent organizational, analytical, and time management skills.
Highly effective interpersonal, writing, and communications skills required.
Familiarity with CMS and applicable compliance requirements.
Ability to work independently with minimal supervision.
Previous state and/or federal regulatory, Medicare Advantage health plan compliance experience.
Previous experience working in compliance product development/compliance software programs.
Flexible and able to adapt to changing priorities and required deadlines.
Able to work effectively with a variety of Departments and leadership levels.
Demonstrate exceptional customer service attitude, including a “positive, can do” approach.
Must be able to work effectively with a variety of Departments and leadership levels.
Must demonstrate exceptional customer service attitude, including a “positive, can do” approach.
NaviHealth partners with health plans, health systems and post-acute providers to manage the entire continuum of post-acute care. We utilize evidence-based protocols to optimize care and bundled payment methodologies to align all stakeholders. The result: optimized care and outcomes, reduced inpatient days, reduced hospital readmissions, and increased patient satisfaction.
NaviHealth ™ is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
Cardinal Health is an Equal Opportunity/Affirmative Action employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex,
sexual orientation, gender identity, national origin, disability, or protected veteran status.
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