Client Relations Compliance Consultant

Emergent Holdings • Detroit, MI

22d

About The Position

The Client Relations Compliance Consultant leverages CMS compliance and business
needs.  This role assists with Compliance operations and performance and
interfaces directly with clients, serving as the primary contact for issues and
requests generated by the client.  The Client Relations Compliance Consultant is
accountable for key measures and performance indicators, as well as
communications with appropriate business owners to resolve issues.

Requirements

• Relevant combination of education and experience may be considered in lieu of degree.
• Bachelor’s Degree in Business Administration, Computer Science, Information Security, or a related field. Seven years of experience in a managed care environment or a related field with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities.
• Strong knowledge of Health Plan member eligibility requirements, including government programs (Medicare, Medicaid).
• Familiar with Medicare Advantage Plan, with specific knowledge of CMS regulations, the Medicare Managed Care Manual, Part C and D regulations, and operational areas such as enrollment, claims, and customer service.
• Working knowledge of HIPAA legislation, privacy rules, and security standards.
• Excellent analytical, organizational, interpersonal, problem solving, and written and verbal communication skills, as well as the ability to apply concepts to practical situations.
• Flexible and able to adapt to changing priorities and required deadlines.
• Strong skills in leading and facilitating multi-disciplinary groups in order to execute on completed Impact Assessments in a timely and accurate manner.
• Ability to work effectively both independently and within a team environment.
• Excellent organizational skills and the ability to communicate effectively through written and oral communications with individuals at various levels of authority.
• Working knowledge of PC applications (Word, Excel, PowerPoint and Outlook).

Responsibilities

• Creates and manages user accounts in a variety of systems, including Medicare Advantage Systems, in compliance with internal policies and system access protocols.
• Maintains Role-Based Access Matrices.
• Reviews and submits collateral and communications to CMS for approval.
• Facilitates communication between customers and internal constituents regarding regulatory activities and changes.
• Collaborates with peers to understand impact of compliance/non-compliance for products and customers.
• Assists peers with the identification and facilitation of relevant and timely communications to appropriate audiences.
• Collaborates with Service Delivery personnel to identify and document the impact of regulatory changes and prepares communications for clients.
• Develops and delivers appropriate management-level reports identifying instances of non-compliance.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level