Compliance Specialist

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We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Compliance Specialist will be responsible for the coordination of all complaints received through various methods, to be reviewed, investigated and draft responses prepared, and to facilitate approval and response submission in accordance with required timeframes. The Specialist will assist with the compliance activities related to PBD’s accreditations, certifications, licenses, and regulatory requirements (e.g., URAC PBM accreditation, regulatory and utilization review licenses). The Specialist will assist with compliance and regulatory audit activities, corrective action plans, market conduct exams, and compliance submissions.

Qualifications

• High school diploma or GED required. Associates degree preferred.
• Three (3) years of compliance, legal, quality assurance/audit or healthcare operations required. Prior experience in complaints or compliance preferred.
• Experience in the creation or review of policies, procedures, and reports and ability to assess controls needed to meet requirements, render decisions and troubleshoot issues.
• Proficient in performing work that requires knowledge of compliance and legal concepts, with emphasis on corporate, business law, or compliance as well as other areas of general practice.
• Strong critical thinking, analytical, problem solving, time management and organizational skills
• Strong interpersonal skills with the ability to interact with internal and external clients and vendors.
• Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Essential Accountabilities

• Ensure thorough research is completed to determine if all necessary information is received and obtained from internal systems.
• Create communication documents and letters to external customers, including but not limited to regulatory agencies, in accordance with the organizational processes and regulations. This will include but is not limited to requesting medical records, invoices, and acknowledgement letters. 
• Ensure verbal and written correspondence regarding complaints and regulatory investigations are in compliance with regulatory standards and work is prioritized based on expediency. Ensure that all outgoing communications are HIPAA compliant and sent to the correct parties. Coordinate and complete requests by prioritizing and monitoring them to ensure timely turn-around.
• Knowledge of program standards, regulations and legislation to aid in the development and implementation of processes and documentation necessary for accreditation, certification, registration and licensing.
• Assist project teams performing necessary preparation activities for accreditation, certification, registration and licensing submissions and mid-cycle audits and renewals; including but not limited to gathering requested information, updating, and reviewing documentation for accuracy and other activities as deemed necessary.
• Assist with monitoring and evaluating programs and operations compliance with accreditation standards and any state or federal regulatory requirements as necessary.
• Support program requirements, meetings, note taking and dashboard maintenance for the Quality Management Committee.
• Support the organizational policy and procedure process to ensure all functional areas are maintaining documentation.
• Assist in monitoring and compliance with accreditations, requirements, policies, and procedures to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance, including remediation efforts for instances of non-compliance.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $30.00 - $35.00 hourly
 

Compensation may vary based on factors including but not limited to skills, education, location and experience. 

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship and immigration status, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub app.