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Compliance Specialist

Company: Health Partners Plans
Location: Philadelphia
Posted on: April 2, 2024

Job Description:

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.We offer Medicaid, Medicare, and Children's Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We're also committed to boosting the health of our community through outreach, education, and events. Founded over 35 years ago, Health Partners Plans continually develops new ways to encourage better health outcomes and has received national recognition for our innovations in managed care. While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ. Perks of JHP and why you will love it here:

  • Competitive Compensation Packages including 401(k) Savings Plan with Company Match and Profit Sharing
  • Flextime and Work-at-Home Options
  • Impact on the communities we service
    We are seeking a talented and enthusiastic Compliance Specialist to join our team!This position is responsible for support of the administration and oversight of Health Partners Plans' (HPP) Compliance Program. The Compliance Specialist will support the Compliance management team by ensuring ongoing compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care. In close collaboration with all business units, this position will provide support throughout HPP in the organization's efforts to achieve key objectives, maintain and improve compliance. The Compliance Specialist will play an integral role in researching and tracking regulatory issues and maintaining full regulatory compliance. This role is responsible for supporting a diverse range of compliance-related responsibilities associated with HPP's Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, Pennsylvania CHIP lines of business.As the Compliance Specialist your daily duties may include:
    • Receive, coordinate follow-up and respond to all requests for information and/or clarification received from regulatory entities or internal business units/departments.
    • Once documentation is ready to submit to a regulatory entity, the Compliance Specialist will review prior to submission
    • Assist management in reviewing, clarifying and disseminating pending and newly enacted regulations, sub-regulatory guidance and state contractual revisions to appropriate HPP staff
    • Serve as a point of contact for all internal departments for management of CMS/ DHS communications including, but no limited to: HPMS issued guidance, Medical Assistance Bulletins, Managed Care Operations Memos, System Notices, relevant regulatory and sub-regulatory guidance, and HealthChoices/ CHIP contractual revisionsAssist in workgroups for implementation of Medicare, HealthChoices, and CHIP requirements
    • Assist with development of internal policies and procedures
    • Ensure the timely and accurate review, routing and tracking of regulatory submissions
    • Support the Compliance department with data reporting needs
    • Submit marketing materials to CMS for regulatory review and approval
    • Provide support for both internal and external audits when necessary
    • Review audit results when appropriate in order to enhance Compliance monitoring activities
    • Provide support for Compliance monitoring activities when necessary
    • Assist in the investigation of both actual and suspected compliance risks
    • Maintain accurate and timely reporting/project mechanisms that afford management with easily accessible information regarding the status of compliance issues
    • Develop "job aids" conveying compliance requirements for use by the Compliance department
    • Develop and maintain collaborative relationships with internal and external customers
    • Perform other duties as assignedQualifications:
      • Bachelor's Degree Preferred
      • Experience: 3-5 years firm managed care operations or compliance experience required.
      • Preference to demonstrated experience with Compliance program management and support for a managed care organizationSkills we value:
        • Strong written and verbal communication skills working with various levels within and outside of the organization
        • Knowledge of CMS/DHS compliance standards and regulations
        • Strong problem-solving skills. Ability to identify issues in health plan or delegated entity operations, administrative activities, and other areas which could result in non- compliance with CMS or health plan requirements
        • Ability to work independently and collaboratively with internal departments
        • Proficient in Microsoft Office products (e.g. Microsoft Word, Excel, Outlook E-mail, Power Point, etc.)
        • Ability to participate as a team player to meet all work requests/deadlines within standards to contribute to the organization's overall performance
        • Ability to provide continual updates to management on all issues, bringing those with potential impact/ risk to the attention of management immediately
        • Ability to accept and manage multiple priority issues/assignments and work autonomously without continual intervention by management to complete tasks
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Keywords: Health Partners Plans, Philadelphia , Compliance Specialist, Other , Philadelphia, Pennsylvania

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