Compliance Specialist

APS Health Care PR

just now

About The Position

The Compliance Specialist will perform ongoing risk assessment activities focused on regulatory and compliance areas associated with organizational operations and performance. This key individual will be accountable for elaborating and overseeing regulatory & compliance matters designed to assess and evaluate adequacy, effectiveness and compliance of policies, procedures, laws and regulations.

Requirements

Bachelor’s Degree in Business Administration, Managed Care or a Behavioral Health Field; Master’s Degree preferred.
Minimum 3 years of experience in auditing, financial auditing, compliance, healthcare, care management or related field preferred.
Knowledge of the healthcare industry and managed care processes.
Knowledge regarding audit processes and work plans preferred.
Knowledge of current Fraud, Abuse and Waste deterring techniques preferred.
Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.

Responsibilities

Oversees the creation and maintenance of an appropriately structured monitoring process regarding regulatory & compliance areas, liaising with key members of Management and other departments within APS.
Manages and assures completion of auditing activities through effective performance, time/budget management, progress metrics, and effective report revisions.
Provides periodic and/or requested reporting to key business leaders regarding compliance plan, schedules and status.
Performs all corresponding investigations regarding instances of non-compliance with State and Federal Laws & Regulations, healthcare utilization, corporate policies and procedures.
Reports any identified or referred instances of non-compliance with State and Federal Laws & Regulations, to the Compliance Officer and Committee.
Elaborates reports and statistical analysis based on all instances of non-compliance with State and Federal Laws & Regulations, healthcare utilization, corporate policies and procedures.
Elaborates and conducts compliance trainings to APS-PR personnel in collaboration with the Compliance Manager.
Provides direct assistance in the preparation, coordination and tracking of: Compliance plans, Compliance Committees, compliance trainings, enforcement of corrective action plans, and policies and procedure review & development.
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
And all other duties assigned by the manager and/or supervisor.