Regulatory Affairs Compliance Specialist (Managed Care) Job in New York 10016, New York Us
Assists with the Implementation of the compliance assessment, auditing and monitoring program; responsibilities include coordinating external audits and, in some cases, conducting internal compliance audits to ensure compliance with contractual and regulatory requirements. The program includes analyzing risk assessments, performing audits, creating reports, educating and following up with business area to ensure processes exist to demonstrate compliance. Supports enterprise with compliance related training inclusive of compliance Plan, Fraud and Abuse Plan and compliance responsibilities associated with audits. Investigates, summarizes findings, and reports suspected fraud, abuse, and non-compliance to Compliance Officer, Privacy Officer or State Regulatory Agency, as applicable.
- Develop organizes, analyze, and implement procedures
- Review, analyze and interpret regulatory requirements in a clear and concise manner
- Clear and concise report writing and presentation skills
- Meet deadlines with attention to detail
- Communicate effectively with employees at all level
- Exercises good judgment under pressure
- Submisssion of Marketing Materials through CMS HPMS system
- Assist with the identification of any deficiencies and facilitation development corrective action plans.
- Identification of priority areas for auditing.
- Assist ing the development of audit tool development where necessary.
- Assist with monitoring and implementation of corrective action plans.
- Escalation of issues when necessary.
- Serve as a resource to departments and health plans on compliance issues.
- Other duties and responsibilities as assigned.
Bachelor's Degree required along with excellent interpersonal, analytical and communication skills
• Minimum three years prior experience working with a compliance program, member services, enrollment or provider relations desired
• Intermediate skill with MS Office tools (including Excel, Word, Power Point ), Outlook
To begin making a difference, apply on-line at:
www.archcare.org/careers.html.
EOE
If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1307071-1789-3072