Senior Compliance Associate, Compliance

Qualifications

Education
Bachelor's Degree with 8 years’ experience Required OR
Master's Degree with 6 years’ experience Required

Experience
8 Years Medicare Advantage or Managed Care industry (must include experience with HIPAA and FWA); required (with Bachelor's degree Required).

OR
6 Years Medicare Advantage or Managed Care industry (must include experience with HIPAA and FWA); required (with Master's degree Required).

***Compliance experience is highly preferred

Licenses and Certifications
None Required

Skills
Thorough knowledge of CMS guidelines, process and systems
Demonstrated knowledge of regulatory compliance policies and procedures in a managed care environment.
Solid knowledge of Microsoft Office (Excel, Word, PowerPoint)
Ability to handle multiple projects and competing priorities
Strong written, verbal, listening and communication skills having the ability to understand and communicate appropriately to the targeted audience
Strong analytical skills having the ability to identify an issue, conduct an analysis to determine business impact (including gap analyses) and identify solutions
Strong project management skills - having the ability to effectively manage multiple priorities simultaneously by maintaining established time frames, adhering to work plans and communicating changes effectively
Ability to work independently and with a team

Job Description

Operations:
Assist the director in the implementation of compliance programs, policies, and procedures designed to ensure compliance with all applicable federal laws and regulations associated with the business of SWHR CIN.
Assist and support compliance-related projects and initiatives, participating collaboratively in staff meetings, committees, on projects and teams to resolve issues and to meet compliance program goals.
Provide oversight of Compliance 360 process as it relates to policies and procedures.
Establish and implement a policy and procedure monitoring and oversight plan.
Assist the Privacy Officer with the development, implementation, and maintenance of the privacy program.
Develop, implement, and maintain an effective fraud, waste, and abuse (FWA) program.

Auditing:
Execute privacy audits and monitor areas of potential risk and compliance.
Maintain database/log of privacy monitoring, audits, results, and corrective action plans.

Investigation:
Conduct FWA and related compliance investigations.
Independently develop and execute appropriate investigation strategies for assigned cases.

Analytics:
Develop, implement, coordinate, and maintain compliance dashboard.
Perform the compliance-related analytics work for oversight and monitoring of policy and procedures compliance to understand historical performance and identify potential future risks.

Education/Training:
Develop and implement compliance-related training materials related to the operation of the compliance program and its initiatives.
Develop and implement a compliance awareness program.
Maintain sufficient knowledge of the regulatory requirements related to the company's business in order to provide guidance to SWHR CIN employees and leadership.