Regulatory Compliance Specialist
8 hours ago
We are seeking a highly skilled Regulatory Compliance Specialist to join our team at Dale WorkForce Solutions. As a Regulatory Compliance Specialist, you will be responsible for communicating Federal and State regulatory requirements to operational areas and conducting follow-up to ensure implementation.
You will analyze and clarify guidance as required, identify possible compliance issues, and assist with investigation and resolution. Additionally, you will assist with monitoring to measure compliance with regulations and guidance, communicate findings to impacted business areas, and complete follow-up to ensure resolution of identified issues.
Key Responsibilities:
- Provide regulatory interpretation, analysis, and make recommendations to management
- Work proactively to ensure business areas are prepared for audits, aware of current guidance, and can produce a compliant universe
- Review indicators and other monitoring tools, spot trends, and identify potential compliance issues, providing feedback to business areas and escalating as required
- Effectively use the Corrective Action Plan policy and procedure to correctly and completely document identification and remediation of all compliance issues
- Coordinate with business area to review regulations, implement corrections if necessary, and track completion
- Coordinate with business area partners to ensure reported issues are updated weekly on the CMS Disclosed Issues Grid
- Help ensure business areas are engaged and prepared to report results at all compliance committees and workgroups
- Act as a liaison between CMS Regional Offices and Independence when needed
- Conduct monthly Call Center Monitoring, reviewing customer service calls, and providing feedback as appropriate
- Able to back up another SME area
- Other duties as assigned
Qualifications:
- Bachelor's degree in a related field or equivalent work experience
- Minimum of 3 years related work experience in managed care or healthcare
- Excellent organizational, verbal, and written communication skills required
- Working knowledge of Microsoft Office products required
Preferred Qualifications:
- Previous compliance experience is preferred
- Knowledge of health insurance is an asset
- Knowledge of Federal and/or State regulations related to the health insurance industry is an asset
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