Compliance Specialist

PRIMARY FUNCTION
The Compliance Specialist ensures compliance with company policies, requirements, CMS regulations, and all other applicable federal and state laws. Clarifies, monitors, administers, and researches various compliance concerns and topics for projects, reports, policies and procedures. 

ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all of the duties that may be assigned.
1)    Clarifies, monitors, administers, and researches regulatory compliance requirements.
2)    Monitors and provides assessments with regards to key compliance initiatives and requirements.
3)    Collaborates with other departments and business partners to manage compliance related complaints and in facilitating related reports.
4)    Implements policies, procedures and practices for the general compliance and operations. Develops and updates EthicsPoint and SharePoint.
5)    Researches and analyzes matters related to existing and new regulatory compliance requirements. Assists with insurance complaint resolutions.
6)    Coordinates the collection of information with other departments needed for the compliance committee, regulatory reviews, validations, and audits.
7)    Assists with the compliance operations across states including the distribution of the Code of Conduct and Standards, compliance with all applicable training requirements, monitoring and auditing of enterprise entities, reporting mechanisms for fraud, waste and abuse, and other compliance related issues.
8)    Investigates, audits, reports, reviews and analyzes necessary data and compliance with governmental regulations and internal policies.
9)    Identifies areas for audit opportunities based on industry performance, regulatory focus areas and risk areas within the organization. 
10)    Establishes and maintains external and internal lines of communication to effectively present department services, policies, procedures and programs.
 
QUALIFICATIONS
EDUCATION: Associates degree required; Bachelor’s degree preferred. Commensurate work experience may be substituted for education.
EXPERIENCE: Minimum 3 years of experience in Compliance required. Previous Healthcare experience required.

KNOWLEDGE, SKILLS AND ABILITIES
•    Ability to work collaboratively and simultaneously on multiple projects. Able to handle significant task-switching. 
•    Ability to maintain in-depth knowledge of the Electronic Health Record (EHR) and other clinical systems.
•    Ability to work effectively within multidisciplinary teams.
•    Excellent written, oral, and presentation communication skills.
•    Ability to analyze documentation. 
•    Detail orientated, analytical and problem solving skills. 
•    Reporting skills.
•    Knowledge of Excel, PowerPoint, Outlook, Word and Medical Terminology. 

TYPICAL WORKING CONDITIONS
•    Sitting, standing and walking
•    May rotate working in the office and remote/telework. If remote, this job must be U.S. based.
•    May require sitting or standing for long periods; also stooping, bending and stretching for files and supplies
•    Requires manual dexterity sufficient to operate a computer keyboard
•    View and type on computer screens for long periods
•    Communicate on phone or in person for long periods
•    Work in a high volume environment

OTHER PHYSICAL REQUIREMENTS
•    Vision
•    Sense of sound
•    Sense of touch
 
PERFORMANCE REQUIREMENTS
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.