The Sr Compliance Specialist will be responsible for ensuring compliance with State and Federal guidelines as well as internal company policies. The Sr Compliance specialist will oversee the activity of two (2) Compliance Monitors to ensure adherence to Federal and State guidelines. Compliance Monitoring will include Part C/Part D/Medicaid-CHP Website reviews, Online Provider Directory Accuracy (OPD) Monitoring, Salesforce and Scope of Appointment audits or any other Compliance Program Monitoring deemed necessary by the Compliance Officer.Job Description
Create, review, and combine Salesforce/Scope of Appointment Medicare audit reports and scorecards monthly. Draft email presenting the results of the Salesforce/Scope of Appointment report and share it with all pertinent stakeholders.
Ensure complete follow up on any inquiries from sales leadership pertaining to Salesforce/Scope of Appointment audit results.
Review and update Medicare/ Medicaid-CHP Website monitoring reports and data trackers monthly. Identify any discrepancies in the report summary document. Capture screenshots of deficient areas and compose final report email and share with department manager.
Create, review, and combine Online Provider Directory Monitoring (OPD) reports. Generate summary reports outlining any deficiencies identified by the Online Provider Directory Accuracy (OPD) monitoring if requested by stakeholders.
Update Audit Risk and Compliance Committee (ARCC), Compliance Committee (CCC) & Compliance Board Reports (BOD) on a quarterly basis.
Participate in Sales Managers’ departmental/divisional meetings and serve as SME to clarify/answer any questions or concerns regarding compliance monitoring results.
Provide Compliance Monitoring (SOA/SF) semi-annual and end of year reports for mid-year/end of year performance reviews for the sales managers.
Conduct coaching/reinforcement sessions with two (2) Compliance Monitors once per quarter or when needed.
Update/maintain Master Sales Audit Dashboard with the audit results for each area of responsibility.
Additional duties as assigned.
Minimum Qualifications:
Must have experience working independently with minimal supervision.
Must have the ability to communicate effectively.
Demonstrated willingness to be flexible and adaptable to changing priorities.
Time management skills with the ability to manage multiple tasks.
Must be able to deliver results under time sensitive constraints.
Computer proficient (i.e., excel, formulas, reporting, pivot tables)
Must be knowledgeable with CMS/ NYSDOH regulations and healthcare compliance.
Associate degree or above
Preferred Qualifications:
Bachelor’s Degree or above
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.EEO Law Poster and Supplement (http://www.dol.gov/agencies/ofccp/posters) All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.