Compliance Specialist

Ram Technologies

23d

About The Position

The RAM Health, Compliance Specialist reports to the Compliance Officer and is responsible for planning, executing, and overseeing compliance monitoring activities to ensure ongoing adherence to federal and state regulatory requirements, contractual obligations, and internal policies. This position plays a critical role in risk identification, mitigation, and resolution through monitoring, training oversight, screening, and corrective action follow-up. The Compliance Specialist collaborates with internal departments and leadership to support a culture of compliance and operational integrity across the organization.

Requirements

3-4 years of experience in healthcare compliance with specific experience in Medicare Advantage regulatory monitoring.
Bachelor’s Degree from an accredited university.
Strong understanding of applicable laws, regulations, and standards impacting health plans (e.g., CMS, Medicaid, HIPAA, OIG).
Experience managing compliance training programs and using learning management systems (LMS).
Familiarity with exclusion screening processes (OIG/GSA) and vendor oversight.
Professional work experience in participation/coordination of audits conducted by external entities (e.g., CMS Program Audits, Data Validation Audits, Compliance Program Effectiveness audits, Timely Monitoring Projects, 1/3 Financial Audits)
Proficient writing expertise: ability to write effectively and succinctly, convey information clearly and concisely without ambiguity and in a logical coherent flow that guides the reader through the text.
Ability to analyze data and facts and draw logical conclusions, sound decision making skills, and meticulous attention to detail.

Nice To Haves

Proficiency in Microsoft Office 365.
Excellent organization skills, ability to manage competing projects and meet tight deadlines.
Active listening, facilitation, and presentation skills.
High degree of discretion in dealing with confidentiality of all compliance-related matters.
Certification in Healthcare Compliance (e.g., CHC, CCEP).

Responsibilities

Monitor for and interpret CMS regulations, sub-regulatory guidance, HPMS memos, CMS transmittals; assess operational impact(s); and ensure timely implementation of required changes.
Assign, track, and monitor completion of all required compliance, Fraud, Waste & Abuse (FWA), and HIPAA privacy and security training for all employees and contractors.
Conduct monthly Office of Inspector General (OIG) and General Services Administration (GSA) exclusion list screening for all RAM employees and vendors; investigate and escalate positive matches as appropriate.
Coordinate client- and leadership-requested root cause analyses (RCA) and corrective action plans (CAPs); ensure timely resolution and monitor for effective implementation through documented follow-up
Analyze monitoring data to identify trends, anomalies, or potential areas of non-compliance; provide actionable recommendations.
Create and maintain tracking tools, reports, and dashboards for compliance monitoring and remediation follow-up.
Collaborate with internal stakeholders to ensure timely responses to Client requests for documentation and audit preparation.
Support the Compliance Department in the development and maintenance of policies, procedures, and other compliance-related documentation.
Maintain current knowledge of applicable federal and state regulations, including but not limited to: CMS Medicare Advantage and Medicaid Managed Care rules, HIPAA, and state-specific health plan requirements.
Support and actively participate in compliance team functions including, but not limited to, compliance risk assessments, review and development of compliance policies & procedures, compliance monitoring work plan development, ongoing monitoring activities, Compliance Committee reporting, annual Medicare Parts C & D reporting, external audit readiness, and external audit support.
Under the direction of the Chief Compliance Officer, assist in preparing the organization for regulatory audits.
Meet regularly with the Chief Compliance Officer to set priorities, ensure work efforts are aligned, and discuss issues and opportunities for improvement.