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Compliance Specialist

Spring Hill, FL

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nnJob Descriptionn**MEMBERS ONLY**SIGN UP NOW***. is currently seeking a Compliance Specialist to support one of our clients in the Spring Hill, FL area. This position will work with the Compliance Officer to administer the Medicare Compliance Program and evaluate compliance issues/concerns within the organization. This person will be responsible for ensuring that the company maintains optimal compliance with appropriate federal, state and local requirements and assures all operations and documentation comply with regulatory and accreditation requirements. This is a contract to hire position. Hours: Business Hours, M-F Pay: Competitive, looking for high experience level Main Job Duties and Responsibilities rn•         Monitor, distribute, interpret and analyze new laws, HPMS memos, regulations and guidance applicable to specified business units. Work with business units to assess potential impact. rn•         Ability to identify regulatory and other compliance gaps within the company and work with appropriate business functions to correct and/or mitigate potential issues. rn•         Complete timely research for regulatory questions on department processes, policies and procedures, or materials for applicable business units. rn•         Review, submit and maintain tracking of materials sent to external regulatory agencies. rn•         Support the collection of data and analyze for regulatory reporting and filing, coordinate and develop reports, and assessment tools to verify compliance. rn•         Act as Liaison with the business units’ subject matter experts, conducting analysis of reporting data business analysis and requirements gathering. rn•         Lead and manage compliance-related process design activities or projects and implementation teams in process improvement activities. rn•         Monitor and assist with external regulatory audits and regulatory reporting. rn•         Develop compliance communications and drive problem resolution. rn•         Analyze data and facts to identify and solve areas of non-compliance. rn•         Reviews state and federal laws, rules and regulations and accreditation standards to keep the company apprised of new regulatory developments. rn•         Assists other departments in understanding and complying with regulatory requirements. rn•         Collaborates with all operational departments to monitor compliance issues. rn•         Partners with Human Resources to track and respond to alleged violations of rules, regulations, policies, procedures, and Standards of Conduct. rn•         Identifies potential areas of compliance vulnerability and risk and develops corrective action plans for resolution of problematic areas. rn•         Provides reports on a regular basis to the Compliance Officer and other leadership. rn•         Maintains effective compliance communication in the organization, including promoting heightened awareness of Standards of rn•         Conduct and understanding of new and existing compliance issues and related policies and procedures. rn•         Monitors, and as necessary, coordinates compliance activities of other departments to remain abreast of the status of all compliance activities and to identify trends. rn•         Coordinates filing of all regulatory forms and required reporting to the Centers for Medicare and Medicaid Services (CMS), the Agency for Health Care Administration (AHCA), NCQA, and other governing agencies. rn•         Coordinates, interacts and assists with responses to CMS or other regulatory/accreditation site visits, audits, surveys, etc. rn•         Reviews and assists in the development of training materials for high risk areas. rn•         Develops audit tools and conducts audits of operations and delegated entities to monitor ongoing compliance with all applicable rules and regulations. rn•         Assists the Compliance Officer with implementing a fraud and abuse awareness program. rn•         Maintains company’s Policies and Procedures repository. Requirements   rn•         Bachelor's degree (B. A.) from four-year college or university preferred; 3 plus years related experience and/or training; or equivalent combination of education and experience. rn•        Expert working knowledge of Microsoft Office software, including Microsoft Excel, Power Point, and Word as well as MS Internet Explorer. rn•         Ability to use multiple software applications proprietary to CMS and its contractors. rn•         At least 3 years of experience with compliance responsibilities in a Managed Care environment is strongly; 3 plus years of auditing and/or Compliance required. rn•         Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. rn•         Ability to work in a fast-paced environment and to effectively prioritize work. rn•         Project management skills are strongly desired. rn•         Experience supporting Medicare Advantage products is required.

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