Compliance Specialist - Jefferson Health Plan

Jefferson Health Plans • Philadelphia, PA

2d • Onsite

About The Position

This position is responsible for supporting the administration and oversight of Health Partners Plans' (HPP) Compliance Program. The Compliance Specialist will support the Compliance management team by ensuring ongoing compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care. In close collaboration with all business units, this position will provide support throughout HPP in the organization's efforts to achieve key objectives, maintain and improve compliance. The Compliance Specialist will play an integral role in researching and tracking regulatory issues and maintaining full regulatory compliance. This role is responsible for supporting a diverse range of compliance-related responsibilities associated with HPP's Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, and Pennsylvania CHIP lines of business.

Requirements

• 3 years firm managed care operations or compliance experience required
• Strong written and verbal communication skills working with various levels within and outside of the organization
• Knowledge of CMS/DHS compliance standards and regulations
• Strong problem-solving skills
• Ability to identify issues in health plan or delegated entity operations, administrative activities, and other areas which could result in non- compliance with CMS or health plan requirements
• Ability to work independently and collaboratively with internal departments
• Proficient in Microsoft Office products (e.g. Microsoft Word, Excel, Outlook E-mail, Power Point, etc.)
• Ability to participate as a team player to meet all work requests/deadlines within standards to contribute to the organization’s overall performance
• Ability to provide continual updates to management on all issues, bringing those with potential impact/ risk to the attention of management immediately
• Ability to accept and manage multiple priority issues/assignments and work autonomously without continual intervention by management to complete tasks

Nice To Haves

• Bachelor’s Degree Preferred
• 1 year of demonstrated experience with Compliance program management and support for a managed care organization Preferred

Responsibilities

• Receive, coordinate follow-up and respond to all requests for information and/or clarification received from regulatory entities or internal business units/departments
• Once documentation is ready to submit to a regulatory entity, the Compliance Specialist will review prior to submission
• Assist management in reviewing, clarifying and disseminating pending and newly enacted regulations, sub-regulatory guidance and state contractual revisions to appropriate JHP staff
• Serve as a point of contact for all internal departments for management of CMS/ DHS communications including, but not limited to: HPMS issued guidance, Medical Assistance Bulletins, Managed Care Operations Memos, System Notices, relevant regulatory and sub-regulatory guidance, and HealthChoices/ CHIP contractual revisions
• Assist in workgroups for implementation of Medicare, HealthChoices, and CHIP requirements
• Assist with development of internal policies and procedures
• Ensure the timely and accurate review, routing and tracking of regulatory submissions
• Support the Compliance department with data reporting needs
• Submit marketing materials to CMS for regulatory review and approval
• Provide support for both internal and external audits when necessary
• Review audit results when appropriate in order to enhance Compliance monitoring activities
• Provide support for Compliance monitoring activities when necessary
• Assist in the investigation of both actual and suspected compliance risks
• Maintain accurate and timely reporting/project mechanisms that afford management with easily accessible information regarding the status of compliance issues
• Develop "job aids" conveying compliance requirements for use by the Compliance department
• Develop and maintain collaborative relationships with internal and external customers
• Perform other duties as assigned

Benefits

• comprehensive package of benefits for full-time and part-time colleagues
• medical (including prescription)
• supplemental insurance
• dental
• vision
• life and AD&D insurance
• short- and long-term disability
• flexible spending accounts
• retirement plans
• tuition assistance
• voluntary benefits, which provide colleagues with access to group rates on insurance and discounts
• tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service
• All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed