Commerical Health Plan Compliance Consultant IV

Responsibilities

• Develops compliance reports by evaluating and summarizing compliance data, audit information, and potential risks and remedies; reporting to management on key compliance drivers, liabilities, and performance indicators (for example, adherence to standards, incorporation of new regulations).
• Conducts compliance investigations by collecting and analyzing quantitative and qualitative data; conducting interviews as appropriate; researching key business issues; identifying potential action steps; and providing input for the creation of corrective action plans for substantiated allegations.
• Collaborates with internal and external stakeholders to conduct company compliance activities; applies established regulations and standards to compliance efforts; provides insight and recommendations for the design, development, and execution of strategic compliance initiatives; and documents compliance activities.
• Assists with and supports the management of projects or compliance components of larger cross-functional projects by coordinating stakeholder contacts; recommending team resources based on project needs and team member strengths; assisting in the development, analysis, and management of project plans; and coordinating project schedules and resource forecasts.
• Maintains regulatory compliance by monitoring regulatory changes; conducting analysis on regulatory impacts; and supporting the implementation of designated changes.
• Coordinates the implementation of compliance efforts by identifying compliance requirements; assessing the current state of compliance to identify gaps and corrective actions; creating or revising moderately complex compliance standards, policies and procedures, and training; and monitoring ongoing compliance adherence.

Requirements

• Bachelor's degree in Health Care Administration, Clinical, Law, Public Health, Business or related field and Minimum six (6) years experience in compliance, health care operations (quality, risk, etc.), audit, finance, regulatory or public policy development, investigations, information security, or insurance/health plan governance or a directly related field. Additional equivalent work experience in a directly related field may be substituted for the degree requirement.
• Four (4) years medical coding experience.
• Four (4) years experience in privacy and security compliance.

Qualifications

• Analyze and interpret complex information, including raw data, information, and variables.
• Apply advanced mathematical techniques such as probability and statistical methods.
• Communicate effectively both orally and in writing.
• Make independent judgments and solve problems.
• Work independently and as part of a team.
• Manage multiple tasks and projects simultaneously.
• Adapt to changing conditions and priorities.

Skills

• Compliance Management
• Cross-Department Coordination
• Getting Work Done Through Others
• Influencing Others
• Technical Communication
• Written Communication

Benefits

N/A

Pay

N/A

Schedule

N/A