Compliance and Contracts Specialist

Description We are offering an exciting opportunity for a Compliance Specialist with a passion for healthcare! The company is a non-profit based in Plymouth, Minnesota. You'll make a real difference as the non-profit connects health insurers with healthcare providers in a niche space.You will be involved in conducting ongoing monitoring and general compliance support, compliance with licensing and contract management, and supporting the legal department. This role also involves conducting routine audits to ensure compliance with applicable state and federal laws and regulations, contractual agreements, and internal policies and procedures.Responsibilities: Support compliance and fraud investigations, internal audit and monitoring activities through data analysis, coordination of file reviews, provider outreach, etc. Analyze, answer, resolve, and document incoming telephone calls from members, providers, internal departments, and external customers and regulators. Monitor and research incoming appeals and grievances requests and inquiries; including potential expedites, from mail, voicemail, fax, and email. Contact members, providers, health plan customers, and delegates as necessary to proactively obtain information required to complete appeals and grievances and educate on the process. Ensure all appeals and grievances are entered in the system and maintain accurate documentation according to State, Federal or Commercial regulatory guidelines. Manage tracking, storage and change management of vendor and client contracts. Review, recommend and implement (after approval) improvements to contract management process. Effectively use skills in Cl Programming, Costpoint, CRM, DCAA, Deltek, About Time, Billing Functions, Compliance, Construction, Customer Service to execute all responsibilities. Establish positive working relationships with stakeholders to provide input on risks and controls while maintaining independence and objectivity.Requirements 2 years of experience in Compliance related roles, ideally within healthcareRobert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 2024 Robert Half. Robert Half is not a law firm and does not provide legal representation. Robert Half project lawyers do not constitute a law firm among themselves. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .