Regional Compliance Coordinator

Primary Duties and Responsibilities:Works collaboratively with the regional Compliance Department and other enterprise Business Unit leaders, Subject Matter Experts (SMEs) and team members to process and complete compliance initiatives and activities according to Managed Care Compliance Program, Policies and Procedures, and regulatory standards.Job responsibilities include, but are not limited to, the following:Supports Compliance Departmenta. Supports the Regional Director in managing compliance requirements so as to maintain full delegation status with all health plans and maintain compliance with all regulatory and applicable accreditor standards.b. Serves as a resource for staff with respect to regulatory requirements, health plans.delegation agreements and provider operations manual requirements for assigned health plansc. Assist with preparing documents and training resources for staff to support complianceAudits internal and externala. Prepares materials for annual and focused health plan (for assigned health plans) and regulator audits, including document and evidence collection and organization.b. Completes audit tools in preparation for health plan annual and focused auditsc. Prepares audit materials, and upon approval of Director, timely, accurately and completely submits final materials to plans and regulatorsd. Maintains complete and organized digital files of all audit material and communications per policye. Works closely with Business Unit Leaders and Subject Matter Experts (SME) in preparation for upcoming live auditsf. Sends reminders notices to stakeholders regarding upcoming auditg. Attends annual and focused live auditsh. Works with Business Unit Leaders and SMEs to collect information and prepare responses to health plan and regulator corrective actionsi. Follows up with business Unit leaders and SMEs to ensure remediation plans andcorrective actions are fully deployed to ensure compliancej. Assists Regional Director with Health Plan and First Tier Downstream and Related Entities (FDR) oversight auditsk. Manages audit tracking tools for assigned health plansl. Assists Regional Director with internal audits as requestsAssist Regional Director in development and updating initial and annual training materials for all new hires and first tier downstream providers, including but not limited to Fraud Waste and Abuse Training, and General Compliance, HIPAA etca. Receive, track, manage all member and provider notification letters from assigned health plans using appropriate tracking toolsb. Works with EIS team to manage configuration fr and timely deployment of all letter templates; ensures letters are tested for accuracy and proper triggering in the Tapestry system.c. File and document all changes/updates/retirements in letter template tracking systemd. Ensure EIS has new templates and require samples with each change to verify implementationCompliance Departmenta. Assist Regional Director with annual compliance evaluationb. Complete and file OIG and SAM Exclusion screenings for, contractors, temp staff, , Vendors contracted with a letter of agreement, Vendors upon hire and monthly thereafter.c. Ensure receipt and filing of exclusion screening of employees and Boards of Directors on a monthly basis.d. Manage and respond to incoming compliance department emails, phone calls within 24hours to ensure communications are completed timelye. Report and escalate issues to management as neededf. Participates in and contributes to all department specific initiatives and department meetings.Additional dutiesa. Perform other duties as assignedb. Adheres to all telecommuting policies and procedures (if applicable).Telecommunicating is a privilege and must demonstrate strict adherence to HIPAA/PHI requirements as well as operational productivity.Knowledge, Skills & Experience Required:

• College degree from accredited institution
• 2-3 years' experience in managed care compliance strongly preferred
• 2-3 years' experience in project management
• Excellent written and oral communication skills
• Proficient data entry skills
• Proficient in Microsoft Office
• Excellent telephone and customer service skills
• Well-organized and a self-starter.
• Must be able to work independently with minimal supervision.
• Must be a problem solver, detail-oriented with excellent follow through
• Must be reliable and possess the ability to stay on-task during work hours.

Pay Range:$29.58 hr - $44.76/hr#LI-CS1