Senior Specialist, Compliance Practices Oversight

Molina Healthcare•Long Beach, CA

14d

About The Position

The Sr Specialist Compliance Practices Oversight serves as support between the Compliance department and the Sales and Marketing functional departments and is the go-to resource for Sales on initial compliance matters. The Sr. Specialist, Compliance Practices Oversight is an integral part of our team, serving as a subject matter expert (SME) for Medicare and Medicaid content regulations and a system and process administrator for the Health Plan Management System (HPMS) supporting operational and marketing content submissions. The qualified candidate will have some experience across both managed care operations functions and execution of compliance practices.

Requirements

BA/BS or equivalent experience
4+ year’s experience in compliance, marketing, compliance programs or audit activities or leading large projects or programs
2+ year’s experience interpreting CMS or other government healthcare regulations or Medicaid contracts Analytical capability, with demonstrated ability to engage others in understanding key concepts
Demonstrated negotiation and consensus building skills
Strong problem-solving and critical thinking skills
Highly organized and detail oriented with proof-reading and quality control skills
Strong interpersonal, written and verbal communication skills; ability to communicate and facilitate communication with individuals at various levels within the organization and with external vendors
Strong technical skills using Microsoft Applications (i.e. Outlook, Word, Excel, and PowerPoint) and other databases and tools as needed
Previous experience working with the Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS)

Nice To Haves

PMP, SixSigma, or equivalent certification

Responsibilities

Serve as a subject matter expert (SME) in the guidelines and regulations for Medicare and Medicaid operational and marketing content
Work with Government Contracts, Compliance Department and Legal departments to define required disclaimers and legal statements for Medicare and Medicaid materials
Act as an administrator for the Health Plan Management System (HPMS) and manage the submission process for defined materials for CMS review according to guidelines and requirements
Ensure timely communication and responsiveness to issues, tracking to resolution
Participate in remediation plan development and implementations when problems are identified
Provide audit support to the Compliance department as needed
Create policy and procedure documentation and define or improve processes as needed
Communicate routinely with stakeholders on requirements, including leading and contributing to meetings across internal and external stakeholders
Create recommendations for stakeholders, compliance and legal teams to consider in response to regulation changes as needed
Participate in the strategic direction, mission, and vision for the Compliance Practices Oversight team, ensuring that Sales functions are enabled to achieve and maintain consistent compliance across all requirements
Drive the team to meet or exceed Sales compliance objectives
Demonstrate facilitation, liaison, and negotiation skills to build consensus among diverse stakeholders
Demonstrate analytical capability, including engaging others in understanding key concepts and their relationships
Lead others across Sales to produce required deliverables and consistently meet deadlines
Ability to execute upon deliverables produced by others across Sales for accuracy and sufficiency, then provide effective feedback to ensure consistent quality
Maintain and enhance industry and company knowledge regarding the key compliance practices outlined in the Position Scope section of this document
Serve as a resource and subject matter expert for compliance practices in support of all Sales functions
Lead in the collection, consolidation, and communication of reporting data and metrics relative to each of the compliance practices