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Compliance Manager

4 months ago

Folsom, United States BRMS Full time

SUMMARY: The Compliance Manager will oversee compliance audits and risk assessments and implementing findings. Partnering with legal counsel and finance departments to identify and monitor critical risk areas, planning for mitigating risks, and developing action plans. Coaching, mentoring, and driving decision making for the Client Services & BRMS as a whole.


Essential Duties and Responsibilities include the following. Other duties may be assigned.

Collaborate with department leaders to periodically conduct a risk analysis and document risk management processes to ensure compliance with HIPAA Security Rule requirements.


Review/establish Company policies that detail compliance procedures for the administration of group health plans, including those regulating the use and disclosure of individually identifiable participant data, as defined by HIPAA and state privacy laws.


Monitor, interpret and provide guidance to the Company regarding DOL, IRS, HHS and state regulations applicable to self-funded group health plans, including but not limited to ERISA, ACA, HIPAA and state laws.


Manage the day-to-day operations of the Compliance Program at the direction of the Senior Vice President, Contracting & Risk Strategy and collaboration with our IT, data, and other cross-functional teams.


Lead compliance initiatives and provide direction to drive results and ensure compliance projects are completed and communicated on time.


Lead the development of compliance training programs (required annual and ongoing training) for BRMS which includes, monitoring training completion, running reports and conducting ad hoc compliance training.


Develop follow-up action based upon audit finding.


Conduct compliance and HIPAA-related investigations, including conducting HIPAA risk assessments and report findings to BRMS leadership.


Participate in prospective client presentations and new business implementation, as requested.


Participation in all implementation meetings; specifically on benefit clarification call.


Prepare educational materials for publication and conduct periodic in-person or virtual workshops about compliance topics applicable to self-funded group health plans.


Respond to inquiries from clients and brokers regarding new and existing regulatory requirements impacting group health plans.


Investigate suspected privacy breaches, notify appropriate federal and/or state enforcement agencies, identify and track remediation efforts, and report risk to Company leadership.


  • Perform other duties as assigned.



Knowledge, Skills, & Abilities:

• Strong computer skills, including Word, Excel, Outlook, and Power Point

• Basic understanding of Salesforce

• Excellent customer service skills, both in person and over the phone

• Must be dependable and maintain excellent attendance

• Ability to maintain confidentiality

• Ability to work independently with little or no supervision

• Ability to grow with changing demands of the position and the company


Supervisory Responsibilities: This job has no supervisory responsibilities.


Qualifications:

• Product knowledge/Working knowledge of health care benefit plans and contracts.

• Experience in HealthCare or insurance industry required

• Ability to work with multiple groups, to produce positive results for customers and the company.

• Relationship building: Proven track record of understanding customers and their underlying needs.

• Demonstrated ability to cultivate deep and long-lasting relationships, internally and externally.

• Demonstrated ability to work well in cross functional teams.

• Build trust by disclosing accurate and relevant information through timely and concise communications.

• Personal attributes: Consistently delivers results with energy, drive, and integrity.

• Acts with the utmost professionalism at all times.

• Acknowledges problems and responds with appropriate urgency.

• Excellent communication (verbal and written) skills.

• Keeps commitments: Strong computer skills including MS Office and sales force automation/CRM tools.


Education and/or Experience: Bachelor of Science, Health Care Administration and minimum of 3 years related experience and/or training; or equivalent combination of education and experience.


Language Skills: Ability to read, speak, and write effectively in English. Ability to interpret documents such as safety rules, memos, letters, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before customers or employees of organization. Ability to effectively address or resolve customer service issues within guidelines of the position.


Mathematical Skills: Ability to add and subtract, multiply and divide with 10's and 100's.


Reasoning Ability: Critical and strategic thinking, ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.


Certificates, Licenses, Registrations: Valid, class C license in state working with no adverse driving record.


Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


While performing the duties of this Job, the employee is regularly required to sit and stand; walk and use hands to finger, handle, or feel. The employee is frequently required to reach with hands and arms and talk or hear. The employee may frequently lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.


Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


The noise level in the work environment is usually moderate.