COMPLIANCE MANAGER

Job Description

Serves as the lead compliance and privacy manager for an assigned SBU(s). Oversees regulatory and contract compliance for business managed by the Care Center. Responsible for the implementation of the SBU Compliance Program, overall HIPAA compliance, including audits, and oversees the preparation for state and customer audits.

• Oversees the implementation and ongoing operation of the Compliance Program for the assigned SBU(s).
• Develops and annually updates a formal written compliance program for the assigned Care Center, and educates the Care Center management team and staff about compliance and the appropriate details of the compliance program.
• Directs federal and state regulatory and compliance activities.
• Customizes corporate policies where necessary to address contractual requirements and work with corporate compliance on any customizations that are required due to state regulatory standards.
• Serves as a liaison for customers on legal and regulatory issues.
• Chairs the local compliance committee meetings.
• Generates periodic reports documenting compliance status.
• Coordinates activities with the Internal Audit and Special Investigations Unit (SIU) on compliance matters including fraud, waste and abuse auditing and monitoring.
• Ensures corrective actions are implemented for all known compliance deficiencies.  Submits reports to the Quality Improvement Committee, Compliance Committee, Care Center Manager and the corporate Compliance Department.
• Maintains expertise related to authorization and non-authorization correspondence requirements from the perspective of ERISA, NCQA, URAC, federal regulations and state law.
• Maintains the database of standard correspondence, notifying policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence.  
• Attends customer meetings to report on compliance matters.
• Serves as central contact for internal and external customers regarding compliance, security, HIPAA, and anti-fraud efforts within the assigned Care Center. 
• Supports internal and external audits and reporting.
• Oversees Care Center-delegated entities and their compliance activities and assure that compliance data from the delegated entities are reported to the QIC.

General Job Information

Title

COMPLIANCE MANAGER

Grade

25

Job Family

Legal Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

9/30/2019

Date Requisition Created

9/27/2019

Work Experience

Compliance, Healthcare

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

• Knowledge of HIPAA, federal and state regulatory processes.
• Strong interpersonal, organizational, and project management skills.
• Ability to research, obtain, coordinate, and integrate feedback and directions from diverse operational groups and organizations into a written product.
• Excellent verbal and written communication skills.
• 5-8 years compliance related experience.
• Experience and thorough understanding of Microsoft Office, flow charting and other relevant software systems and applications.

• Experience working for a Managed Care Company or other health related organization, strongly preferred.
• Masters degree preferred along with a clinical degree to complete file audits and clinical documentation reviews.
• 5-8 years' healthcare compliance experience.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.