Lead Compliance Specialist Commercial Oversight

Posted Date 16 Mar 2024

Experience	5 Years	Salary	72000USD - 138000USD
Job Type	Full Time	Company	EmblemHealth
Job Category	Audit	Qualification	MS Public Health
Gender	Both	Last Date	14 Jun
Vacancies	1	Remote	Yes
Location(s)	New York , United States

Job Description

Ensure⠀compliance⠀and/or⠀identify⠀issues of⠀non-compliance⠀through⠀audits and⠀monitoring.⠀Issue CAPs⠀where⠀needed to⠀functional⠀areas⠀and/or⠀vendors/delegates.⠀Support⠀business⠀with⠀remediation⠀where⠀needed,⠀and⠀approve⠀final CAP.⠀Provide⠀regulatory⠀guidance⠀for⠀functional⠀areas⠀and/or⠀vendors/delegates⠀for all⠀Commercial⠀Products.⠀Lead the⠀execution⠀of the⠀team’s⠀external⠀regulatory⠀audits,⠀examinations,⠀and⠀corrective⠀action⠀plans.⠀Manage⠀projects⠀as needed⠀for areas⠀of⠀non-compliance⠀and for⠀annual⠀compliance⠀assessments.

Responsibilities:

Partner⠀with⠀business⠀units to⠀assist⠀with⠀inquires⠀for⠀guidance.
Issue⠀and⠀monitor⠀CAPs⠀issued to⠀functional⠀areas⠀and/or⠀vendors/delegates⠀for areas⠀of⠀non-compliance.
Monitor⠀and⠀enhance⠀KPI⠀program to⠀work with⠀functional⠀areas to⠀improve⠀operations⠀and issue⠀CAPs when⠀necessary⠀for areas⠀of⠀non-compliance.
Conduct⠀audits⠀annually⠀with⠀functional⠀areas⠀and/or⠀vendors/delegates⠀and issue⠀where⠀necessary⠀CAPs for⠀areas of⠀non-compliance.
Partner⠀with⠀Commercial⠀Compliance⠀Implementation⠀Team when⠀needed to⠀ensure⠀functional⠀departments/vendors/delegates⠀are in⠀full⠀compliance⠀with all⠀actionable⠀and⠀informational⠀regulatory⠀guidance.
Manage⠀the Plan⠀participation⠀in⠀preparing⠀for and⠀responding⠀to⠀external⠀audits to⠀ensure the⠀Plan has⠀the⠀appropriate⠀data⠀submitted⠀accurately⠀and on⠀time and⠀that⠀functional⠀area⠀and/or⠀vendors/delegates⠀are⠀prepared⠀for⠀regulator⠀interviews.
Lead⠀the⠀creation⠀and⠀monitoring⠀of any⠀CAPs for⠀external⠀adverse⠀regulatory⠀actions.
Maintain⠀and update⠀centralized⠀trackers⠀of⠀compliance⠀(CAPS,⠀regulatory⠀reports,⠀ERM, etc.)⠀and⠀department⠀P&Ps.
May⠀develop,⠀lead,⠀manage/mentor⠀staff.

Qualifications:

Bachelor’s⠀degree⠀(Required)
Advanced⠀degree⠀(MPH, MHA,⠀JD and/or⠀MBA)⠀and/or⠀professional⠀certification⠀(Preferred)
5⠀– 8+⠀years’⠀work⠀experience⠀in⠀regulatory⠀healthcare⠀operations⠀compliance⠀(Required)
Thorough⠀knowledge⠀of State⠀and/or⠀Federal⠀programs⠀operations⠀and⠀regulations⠀(Required)
Proficiency⠀in the use⠀of⠀Microsoft⠀Office⠀(Word,⠀Excel,⠀Access,⠀PowerPoint,⠀Outlook,⠀Teams,⠀etc.)⠀(Required)
Strong⠀organizing,⠀prioritizing,⠀analytical,⠀and⠀problem-solving⠀skills;⠀and⠀outstanding⠀attention⠀to details⠀(Required)
Proven⠀ability to⠀establish⠀and⠀maintain⠀relationships⠀of trust⠀with⠀departmental⠀staff and⠀management⠀(Required)
Proven⠀ability to⠀coordinate⠀and lead⠀interdepartmental⠀work teams⠀and meet⠀established⠀goals⠀(Required)
Must⠀be goal⠀oriented⠀and able⠀to meet⠀tight⠀deadlines⠀while⠀handling⠀multiple⠀priorities⠀(Required)
Must⠀be a team⠀player and⠀able to⠀take⠀direction⠀from⠀multiple⠀sources⠀(Required)
Proven⠀ability to⠀effectively⠀manage⠀multiple⠀tasks/projects⠀with⠀competing⠀priority⠀levels/deadlines⠀(Required)
Excellent⠀communication⠀skills⠀(verbal,⠀written,⠀presentation,⠀interpersonal)⠀with all⠀types/levels⠀of⠀audience⠀(Required)
Ability⠀to arrange⠀work⠀schedule⠀to meet⠀deadlines⠀from⠀multiple⠀sources⠀and engage⠀staff⠀throughout⠀EmblemHealth⠀to assist⠀in the⠀completion⠀of duties⠀(Required)

Additional Information