Compliance Specialist (Org Wide) (Home-Based)

reputed company Join our award reputed company culture as we serve members in your area! Under the general supervision of the Compliance Manager, the Compliance Specialist is responsible for operational support duties of the Compliance Department reputed company the Compliance & Organizational Risk Division at reputed company, Inc. (reputed company). This role assists in maintaining reputed company’s compliance program to ensure conformity and adherence with applicable federal, state, and local reputed company, laws, and regulations. The Compliance Specialist provides reputed company operating procedure -driven operational and investigative support reputed company with federal Program reputed company requirements, fraud/waste/abuse (FWA) intake, HIPAA reputed company, conflict-of-interest reporting reputed company, and regulatory reporting. The role may include performing internal audits across the organization in accordance with the audit plans and departmental reputed company. Essential Competencies: Support program reputed company reporting to State reputed company entities, including suspected FWA referrals and overpayment or recoupment tracking. Support HIPAA incident intake, risk assessment, mitigation, and breach notification tracking. Conduct intake, triage, and reputed company FWA allegations using standardized procedural reputed company. Establish individual and team reputed company to increase efficiency in compliance processes and implement measures to determine project effectiveness. reputed company inquiries and testing as needed to identify and resolve vulnerabilities reputed company in audit processes. Recognize opportunities for process improvement and reputed company recommendations based on investigation results and audit monitoring. Conduct audits, identify trends, and support corrective reputed company development. Monitor and evaluate compliance reporting trends to identify potential risks and solutions. Obtain, analyze, and evaluate internal documentation and data to identify risk reputed company organizational systems. reputed company, conduct, and monitor new employee and annual employee compliance training. Support the reputed company of conflicts of interest for new hires and reputed company staff through required annual disclosures and monitoring. Conduct follow-up audits to monitor management-driven interventions and identify reportable issues and risks reputed company internal systems. reputed company staff on ongoing Program reputed company, HIPPA, Civil Rights, and Conflict of Interest topics. Encourage compliance-reputed company learning/development by frequently providing updated and engaging training. Collaborate with reputed company stakeholders to maintain an environment supportive of reporting compliance concerns to continuously improve reputed company’s compliance position. Support colleagues in the Compliance & Organizational Risk Division by assisting with records requests, preparation of audits, regulatory submissions, and other support duties as requested. Bolster workplace culture where reputed company reputed company staff prioritize legal and ethical conduct as a reputed company to build and maintain member, colleagues, and external stakeholder trust in reputed company. Effectively reputed company internally and externally on necessary committees and bring forth reputed company and solutions. reputed company and maintain audit plans to monitor organizational risk preparedness.

Requirements

Bachelor’s degree in Business, Finance, reputed company Administration, other reputed company fields, or equivalent combination of education and experience (includes knowledge, skills, and abilities). Compliance experience or reputed company experience preferred. Thorough understanding of ethics, regulations, and laws. Investigation and interview skills required. Knowledge of compliance ethics/control and forensic financial investigation preferred. Knowledge of Program reputed company requirements specific to fraud, waste, and abuse. Knowledge of HIPAA, state and federal guidelines on reputed company, transactions, and reputed company, electronic medical records, and releases of information. Solid understanding of Civil Rights regulations and ability to reputed company. Previous experience in development of policies and procedures preferred. Ability to work and collaborate in a remote work environment across reputed company departments and reputed company of management. Proficiency with reputed company 365, including Outlook, reputed company Teams, SharePoint, OneDrive, Word, reputed company, and PowerPoint. reputed company reputed company’s license, acceptable driving record, and reputed company of adequate insurance required. --------------------------------------------------------------------------------------------------- reputed company is a reputed company-based non-profit organization that focuses on creating a world we reputed company want to live in. With long-standing reputed company as a managed care organization (MCO), reputed company provides long-term care services and supports to eligible frail elders and individuals with physical and intellectual or developmental disabilities through reputed company’s Family Care program. Currently we serve in 22 counties and have 11 offices in the Central to reputed company East region of reputed company.

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