Compliance Officer Jobs

About The Position

Requirements

• Possess strong oral and written communication skills.
• Ability to work independently on multiple tasks.
• Proficient in Microsoft applications.
• Highly organized and attentive to detail.
• Strong problem solving and analytical skills.
• Successful completion of Health Care Sanctions background check.
• Associates degree plus 5 years’ experience in Managed Care, including member services, medical management and/or claims processing OR Bachelor’s degree plus 1 year experience, OR each year of experience may be substituted for each year of college not completed.
• Knowledge of governmental regulations related to Managed Care Commercial and Medicare programs.

Nice To Haves

• Past supervisory experience preferred.

Responsibilities

• Provides technical consultation to G&A staff including analysis, problem solving, and decision making of complex cases.
• Communicates and implements procedural changes in response to new or revised regulatory requirements for multiple lines of business.
• Coordinates and/or oversees daily workload and functional activities of the G&A staff.
• Analyzes findings of departmental monitoring and corporate internal audits related to G&A.
• Develops and implements corrective action plans as indicated.
• Assists the G&A Manager with external audits, site-visits, department and corporate policy revisions, etc..
• Coordinates submission of data for the Annual Data Validation Audit with other departments.
• Implements various special projects as assigned by the Manager or Compliance Officer.
• Collaborates with IS and department staff to improve and/or maintain the Grievance and Appeals Tracking System (GATS) or other systems to meet various reporting requirements.
• Monitors for data integrity.
• Responsible for review and analysis of monthly, quarterly, and annual G&A reporting.
• Performs other job-related duties as assigned.