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Compliance Coordinator II

2 months ago

Washington, United States American Foreign Service Protective Association Full time
AFSPA is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity and Affirmative Action Employer, making decisions without regard to race, color, religion, sex, sexual orientation, national origin, age, veteran status, disability, or any other protected class.

*A Resume is required for consideration. Application submissions without a resume included will be automatically disqualified from consideration.*

Compensation for this position is in the $50k range to $ 57k range depending on qualifications and experience.

We offer benefits that include subsidized Medical and dental coverage. Other optional benefits include 401K, Vision, Life Insurance, & more.

Hybrid work schedule until otherwise notified. Hybrid work schedules are based on business needs and may require you to have to work in the office up to 4 days per week.

Summary:

The Compliance Coordinator supports the Compliance Department and its program to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA), health care laws and regulations, and federal program requirements set forth by the U.S. Department of Health and Human Services (HHS)/Office of Civil Rights (OCR), the U.S. Office of Personnel Management (OPM)/Federal Employees Health Benefits (FEHB) Program, the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), and other applicable health plan/insurance regulators.

The Compliance Department seeks a Compliance Coordinator who is an analytical thinker with strong problem-solving, critical thinking, and solution-oriented skills. Meticulous attention to detail with the ability to multi-task. Ability to work comfortably under pressure and deliver on tight, competing deadlines. Ability to work independently and as part of a team. Ability to identify ambiguity. Excellent documentation, report generating, communication, and IT/computer skills.

Compliance Coordinator II is subject matter expert in One functional area (Accreditation, Plan Design, or Agreements of Affiliation).

Duties and Responsibilities:

Accreditation

1. Ensure plan and delegated entity activities comply with Plan Performance Assessment (PPA) standards and requirements in fulfillment of the Federal Employees Health Benefits (FEHB) program contractual obligations and AAAHC*.

2.Maintain accreditation readiness throughout the calendar year*.

3. Develop, enhance, organize, and maintain accreditation, PPA, and the Quality Management Committee (QMC) documents*.

4. Coordinate and implement plan and delegated entity audits and validation of policies and processes*.

5. Coordinate QMC meeting logistics, reports, documents, communication, and activities*.

6. Create QMC meeting agendas, reports, documents, program descriptions, work plans, talking points, related documents, and meeting minutes*.

7. Coordinate and participate in delegated entity and vendor meetings in support of accreditation, PPA, and QMC*.

8. Prepare Board of Director PowerPoint slides and talking points*.

9. Coordinate the implementation and monitoring of quality improvement corrective action plans and requests for improvement*.

10. Other duties as required*.

11. This is an essential position. During organizational closures, this position will be required to perform all

the items above*.

Plan Design

1. Prepare the plan's annual benefit proposal and rate filing.*

2. Produce the plan's annual brochure and .*

3. Facilitate plan's annual brochure update training.*

4. Analyze OPM carrier letters and listserv communication.*

5. Prepare the plan's annual contract oversight letter.*

6. Prepare materials for AFSPA's governing body and committees.*

7. Support the plan's efforts on Plan Performance Assessment.*

8. Support the Plan's efforts on accreditation.*

9. Draft regulatory responses, reports, documentation, and member notification.*

10. Submit regulatory reports and documentation.*

11. Monitor and reply to the Compliance Department inbox and secure communications.*

12. Participate in delegated entity and vendor meetings in support of plan design*.

13. Other duties as required*.

14. This is an essential position. During organizational closures, this position will be required to perform all

the items above.

Agreement of Affiliation

1. Draft Agreements of Affiliation (AOA).*

2. Conduct AOA negotiations on behalf of AFSPA*.

3. Audit, organize, and maintain AOA database and files*.

4. Communicate with plan administrator on AOA and provider electronic funds transfer (EFT) status*.

5. Create and update AOA content on plan website(s) *.

6. Create and maintain AOA provider material*.

7. Coordinate the annual health care guidelines communication to providers*.

8. Participate in provider, delegated entity, and vendor meetings in support of AOA's*.

9. Support the plan's efforts on PPA.*

10. Support the Plan's efforts on accreditation.*

11. Other duties as required*.

12. This is an essential position. During organizational closures, this position will be required to perform all

the items above*.

Requirements

High school diploma AND Minimum of two years of health insurance administration/plan or clinical experience; regulatory, health care compliance, or accreditation/quality improvement experience; or equivalent combination of education and experience. College degree is preferred.

Must be able to work independently, have superior attention to detail, outstanding presentation and writing skills, with the ability to work on their own initiative and as part of a team. Compliance Coordinators are expected to be well organized, detailed oriented, have strong problem-solving and critical thinking skills, work comfortably under pressure, and deliver on tight deadlines.