Lead Compliance Specialist, Medicaid - Remote

Responsibilities

• Conduct regulatory research to address compliance inquiries.
• Provide regulatory guidance and support for business process improvement efforts.
• Communicate with business leadership regarding events, training, and processes related to regulatory compliance initiatives and/or memos.
• Conduct monitoring and auditing of assigned business areas.
• Ensure that business areas/delegates understand and address all actionable memos or directives and upload proof of implementation to centralized Compliance Department repository.
• Update and maintain centralized Compliance Department repository records as necessary and appropriate.
• Support external audits or regulatory requests as needed.
• Provide business areas with regulatory guidance to address and mitigate performance or monitoring gaps while ensuring regulatory requirements are met.
• Support business areas in creating and updating P&Ps, trainings, reports, monitoring activities and any project related function to ensure compliance with regulatory memos and audits by internal stakeholders, vendors, and delegates.
• Contribute to Compliance Department committee and subcommittee materials as needed.

Qualifications

• Bachelor’s degree (Required)
• Advanced degree (MPH, MHA, JD and/or MBA) and/or professional certification (Preferred)
• 5 – 8+ years’ work experience in regulatory healthcare operations compliance (Required)
• Thorough knowledge of State and/or Federal programs operations and regulations (Required)
• Proficiency in the use of Microsoft Office - Word, Excel, Access, PowerPoint, Outlook, Teams, etc. (Required)
• Strong organizing, prioritizing, analytical, and problem-solving skills; and outstanding attention to details (Required)
• Proven ability to establish and maintain relationships of trust with departmental staff and management (Required)
• Proven ability to coordinate and lead interdepartmental work teams and meet established goals (Required)
• Must be goal oriented and able to meet tight deadlines while handling multiple priorities (Required)
• Must be a team player and able to take direction from multiple sources (Required)
• Proven ability to effectively manage multiple tasks/projects with competing priority levels/deadlines (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
• Able to arrange work schedule to meet deadlines from multiple sources and engage staff throughout EmblemHealth to assist in the completion of duties (Required)