Lead Compliance Specialist-Medicare Implementation

2 weeks ago

New York, United States EmblemHealth Full time
Summary of Job

Partner with Pharmacy and Pharmacy delegates (and others as assigned) to ensure they are in full compliance with all actionable and informational regulatory notices. Identify new and revised regulatory guidance; create paths of communication to business units. Ensure that Pharmacy (and other business areas as assigned) has implemented regulatory requirements, by collecting artifacts that demonstrate that process, operations, trainings, policies, and procedures have been updated. Provide subject matter expertise and guidance for Pharmacy/ assigned business areas as it relates to day-to-day needs, including but not limited to, implementations, and corrective action plans. Manage projects as needed.

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 ensuring 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 (PharmD, MPH, MHA, JD and/or MBA) and/or professional certification (Preferred)
•Strong knowledge of Medicare Part D regulations (Required)
•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)
•Ability to arrange work schedule to meet deadlines from multiple sources and engage staff throughout EmblemHealth to assist in the completion of duties (Required)

  • Product Specialist, Medicare

    2 weeks ago

    New York, United States NYC Health Hospitals Full time

    MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned...

  • Compliance Specialist

    7 days ago

    New York, United States Marsh & McLennan Companies, Inc. Full time

    Mercer, a place where extraordinary individuals can do their best work and lead their best lives! We believe in camaraderie and collaboration, no matter what your role, level, experience or background. Mercer is seeking candidates for the following Compliance Specialist, Compliance, Specialist, Marketing, Investment, Business Services, Support

  • Compliance Consultancy Director

    2 weeks ago

    New York, New York, United States Compliance Recruitment Solutions Full time

    Compliance Consultancy Director - Previous Compliance Funds Experience and 1940 Act/NFA/CFTC Knowledge Required Ref: 4015G3 $200K - $220K + Bonus + Benefits New York City Our Client, a growing and dynamic regulatory consulting firm based in New York and London, are looking to hire an experienced compliance professional to join their New York Regulatory...

  • Compliance Auditor

    1 week ago

    New York, United States Metropolitan Jewish Health System Full time

    The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life...

  • Solution Implementation Specialist

    2 weeks ago

    New York, New York, United States ABM Industries Full time

    Job DescriptionSolution Implementation Specialist is a vital part of the technology team, responsible for client-facing system implementation that includes preconfiguring/prepping the applications for both existing and new clients, conducting training for frontline employees, monitoring system adaption, and being able to understand and present Client data...

  • Legal Compliance Specialist

    5 days ago

    New York, United States Archstone Builders LLC Full time

    Legal Compliance Specialist, New York, NY Archstone Builders LLC, one of the leading construction mgmt firms, is seeking candidates for a Legal Compliance Specialist position to consult with legal counsel & report to mgmt on compliance matters; monitor, research & analyze local, city, state & fed laws & regs for compliance & of changes...

  • Healthcare Compliance Specialist

    3 weeks ago

    New York, United States Healthcare Enterprise Full time

    Job DescriptionJob DescriptionThe Compliance Specialist oversees the Compliance Program for the Home Care agency, ensuring adherence to local, state laws, and regulations outlined by the New York State Department of Health, Office of Medicaid Inspector General, and company policies. This role includes the continual implementation of the Code of Conduct and...

  • Legal Compliance Specialist

    1 week ago

    New York, New York, United States Archstone Builders LLC Full time

    Legal Compliance Specialist, New York, NY Archstone Builders LLC, one of the leading construction mgmt firms, is seeking candidates for a Legal Compliance Specialist position to consult with legal counsel & report to mgmt on compliance matters; monitor, research & analyze local, city, state & fed laws & regs for compliance & of changes that require...

  • Medicare Benefit Advisor

    4 weeks ago

    New York, United States VIllageCare of New York Full time

    **Medicare Benefit Advisor** **Travel Required** COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE! VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization...

  • Medicare Benefit Advisor

    4 weeks ago

    New York, United States VIllageCare of New York Full time

    **Medicare Benefit Advisor - Cantonese/Mandarin/Fujianese** **Travel Required** VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible through new community and...

  • Medicare Benefit Advisor

    2 weeks ago

    New York, United States Village Care Full time

    Medicare Benefit AdvisorTravel RequiredCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible...

  • Medicare Benefit Advisor

    4 weeks ago

    New York, United States Village Care Full time

    Job DescriptionJob DescriptionMedicare Benefit AdvisorTravel RequiredCOME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGECARE!VillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping...

  • Medicare Benefit Advisor

    2 weeks ago

    New York, United States Village Care Full time

    Medicare Benefit Advisor - Cantonese/Mandarin/FujianeseTravel RequiredVillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible through new community and provider based...

  • Medicare Benefit Advisor

    4 weeks ago

    New York, United States Village Care Full time

    Job DescriptionJob DescriptionMedicare Benefit Advisor - Cantonese/Mandarin/FujianeseTravel RequiredVillageCareMAX is looking for a motivated individual for this Full Time role as the Medicare Benefit Advisor. The Medicare Benefit Advisor is part of the VCMAX Business Development Team, and will be responsible for keeping the organization visible through new...

  • Ethics and Compliance Specialist

    2 weeks ago

    New York, United States Larson Maddox Full time

    A well established Utilities company is looking to add on a Ethics and Compliance specialist to their Ethics and Compliance investigation team. This position will engage with different departments to foster trust, mitigate risks, uphold ethical business practices, develop policies and procedures, conduct training, and facilitate communication on ethics and...

  • Implementation Specialist

    3 weeks ago

    New York, United States TMT Full time

    Because we're a GROWING digital marketing agency in the IT Services industry, we are seeking a highly motivated and skilled Digital Implementation Specialist. In a nutshell, your job is delivering amazing customer service every day. You strive to provide extraordinary service. You go above and beyond the call of duty to delight our customers. You'll engage...

  • Implementation Specialist

    6 days ago

    New York, NY, United States Codat Full time

    What we do at CodatCodat helps banks build deeper connections with business customers.We offer products that make it easy to access, synchronize and interpret data from customers’ financial software for specific use cases, such as onboarding suppliers to commercial card programs and underwriting business loans.Codat is used by the largest banks in the...

  • Compliance Specialist

    7 days ago

    New York City, United States Legal Marketing & Staffing, LLC Full time

    Manage and monitor employee personal securities trading, political contribution requests, gifts and entertainment requests, and outside business activities via a compliance software program. Perform confidential background checks of potential investo Compliance Specialist, Compliance, Specialist, Healthcare, Staffing

  • Client Implementation Specialist

    4 weeks ago

    New York, New York, United States Arch Full time

    Our Company Private investments such as venture capital, hedge funds, and private equity make up roughly 25% of the entire investments universe. Traditionally, investors, advisors, banks, families, and managers track hundreds of investments in complicated spreadsheets, file folders, and busy email boxes. Not only is this tedious and time consuming, but it is...

  • Implementation Specialist

    3 weeks ago

    New York, New York, United States Paces Full time

    In the next 30 years, the world will transform every part of the built environment to be climate positive green infrastructure. Knowing what, where, and how to build infrastructure like solar farms is one of the great opportunities of our time.Paces is software for green infrastructure developers to identify the best places to build and manage their...