Brooklyn NY 11201
Job DescriptionAssists with implementing the Compliance Plan. Among other activities, provides auditing, investigational, review assistance for FIDA and MLTC product lines compliance initiatives. Improves the internal control environment by reporting findings. Assists with preparation and tracking of staff compliance training. Maintains Compliance Department logs, reports, and calendars as it relates to FIDA and MLTC. Supports the compliance monitoring program which includes HIPAA site audits of office and marketing field locations. Works collaboratively within the compliance department to assist with implementing controls to enhance the efficiency and effectiveness of the department?s compliance auditing and monitoring oversight.
- Assists the Local Compliance Officer and the Compliance Manager in oversight activities as directed.
- Manages the production of materials in relation to external audits and reviews.
- Reviews and stays current on industry trends and areas of focus.
- Manages the Compliance Department?s administrative duties (e.g., organize relevant files, prepare reports, take minutes of Compliance Committee meetings; etc.).
- Supports the Compliance Manager with regulatory analysis, including the review, summarization, and dissemination of key regulatory updates and changes that affect AlphaCare operations, policy and processes.
- Assists in the development of internal compliance audits and reviews.
- Conducts site visits with the Compliance Manager (e.g., provider sites, marketing events, etc.) to ensure consistency of activities with applicable requirements (e.g. onsite marketing staff observations, interviews, etc.).
- Conducts HIPAA environmental reviews to ensure compliance with privacy rule obligations.
- Oversees record keeping and filing of all CMS/DOH-required reports, marketing material, marketing events, data reporting, etc.
- Conducts initial assessment of marketing complaints/investigations and assist with compliance investigations under the direction of the Compliance Manager, including conducting interviews, reviewing case files, and preparing outcome reports.
- Partners with business areas and review their policies and procedures as needed to ensure regulatory changes have been applied correctly.
- Assists with the functional management of the implementation of compliance control and compliance processes in accordance with the Compliance Work plan.
- Functions as the coordination/contact point for the Compliance Department as needed.
- Participates in the review of marketing compliance field activity calendars (due first week of each month).
- Participates in and serve as an additional coordination point for all internal and external audits.
- Coordinates with the Compliance Manager regarding inquiries, complaints/grievances and flags for review with potential violations of internal/external regulatory policies.
- Supports the Local Compliance Officer and Compliance Manager with other duties as assigned.
General Job Information
Job FamilyLegal Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/11/2019
Date Requisition Created2/7/2019
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
- 1-2 years of health care compliance experience.
- Working knowledge of CMS requirements related to Medicare (MAPD, DSNP), DOH requirements related to Medicaid (managed long term care), and an understanding of the New York Fully Integrated Duals Advantage Demonstration (FIDA) preferred.
- Strong verbal, written, research and analytical skills.
- Strong Microsoft Office skills (e.g. Word, Excel, PowerPoint, Outlook, Access, etc.).
- Exceptional project management and interpersonal skills.
- Demonstrated communication, critical thinking, and decision making abilities.
- Knowledge of process improvement precepts.
- Ability to manage multiple projects, often under time constraints, and motivate colleagues towards a common goal.
- Bachelor of Arts or two (2) to three (3) years of health care compliance experience.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
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