JOB SUMMARY
The Compliance Specialists operate under the supervision of the Compliance Director or Compliance Manager, playing a crucial role in reporting and special projects. This role is responsible for providing essential information, detailed analysis, and practical recommendations to ensure Community adheres to all regulatory, legal, and contractual requirements.
In addition to these key responsibilities, the Compliance Specialist conducts thorough research and collaborates with operational teams to devise effective compliance solutions. They also perform internal and external monitoring activities as part of the Compliance program, following the guidelines outlined in the annual audit and monitoring work plan.
JOB SPECIFICATIONS
Internal and External Monitoring
Independently assesses regulatory correspondence for proper prioritization and resolution. Supports the assessment of regulatory correspondence to help prioritize and resolve issues. Communicates with regulatory contacts when needed and takes part in committee meetings to provide updates to the business. Capable of assisting in preparing presentations. Maintains trackers for all MCO and Federal notices and ensures all actions are tracked through completion. This includes proper risk leveling, identification of action, disseminating to the correct internal stakeholders and escalating issues to leadership. Must possess excellent written and verbal communication skills, attention to detail, as well as project management capabilities.
Internal and External Monitoring
Independently assesses regulatory correspondence for proper prioritization and resolution. Supports the assessment of regulatory correspondence to help prioritize and resolve issues. Communicates with regulatory contacts when needed and takes part in committee meetings to provide updates to the business. Capable of assisting in preparing presentations. Maintains trackers for all MCO and Federal notices and ensures all actions are tracked through completion. This includes proper risk leveling, identification of action, disseminating to the correct internal stakeholders and escalating issues to leadership. Must possess excellent written and verbal communication skills, attention to detail, as well as project management capabilities.
Regulatory Analysis and Reporting
Supports senior compliance specialist in submitting reports and adhering to deadlines. Maintains access to report portals and ensures a thorough understanding of the upload processes. Assists in coordinating efforts to facilitate timely submissions while helping to address any issues that may arise during the reporting process.
Readiness/Operational Review Contact Support
Assists leadership in meeting deliverable deadlines by facilitating the upload and distribution of necessary materials. Keeps leadership organized and on track for all due dates related to readiness and operational reviews. Provides proactive reminders and support to ensure timely completion of tasks and adherence to established timelines.
Research and Development
Conducts thorough research on compliance-related topics, industry trends, and best practices to inform policy development and enhance organizational compliance strategies. This research aids in identifying potential compliance risks and supports the formulation of effective solutions.
Actively contributes to achievement of departmental goals, as identified in Departments annual business plan, including specific departmental process improvement plans and other duties as assigned.
Reports to Position Title: Compliance Director/Manager
QUALIFICATIONS:
Education/Specialized Training/Licensure:
BA/BS in Healthcare Administration, Business Administration, or related field.
2 years of experience in project management and regulatory experience activities.
Master's Degree preferred
Work Experience (Years and Area):
Minimum 2 years in the healthcare payor industry (Medicare/Medicaid) or similar field required.
Software Proficiencies:
Microsoft Office (Word, Excel, PowerPoint, MS Teams, MS SharePoint, Outlook)
Other:
Understanding of Texas health insurance market and regulators such as TDI, HHSC, and CMS.
