Compliance & Policy Specialist

WEB-TPA, Inc.

United States

Ibrido

USD 78.000 - 126.000

Tempo pieno

5 giorni fa

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Vantaggi offerti da questo lavoro

Health insurance

Income protection

Leave benefits

Retirement plan

Paid time off

Wellness program

Descrizione del lavoro

Florida Blue seeks a seasoned compliance professional to support UM and enterprise-wide compliance initiatives. You will interpret laws, develop policies, lead audits, and coach teams across departments to ensure NCQA and CMS standards are met.

The ideal candidate has 5+ years of related experience, a related bachelor’s degree, and proven ability to manage complex projects. This hybrid role offers comprehensive benefits and a competitive salary, with opportunities to influence outcomes and

Competenze

5+ years related work experience.
Related Bachelor’s degree or additional related equivalent work experience
Demonstrated experience with audits that the organization’s programs are consistently administered in compliance with organizational policies and procedures, contractual obligations, rulings, laws and government regulations.
Proven experience leading large, complex departmental and/or divisional projects. Plan, organize, monitor and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements.
Ability to Identify risks, evaluate controls and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical or improper business practices.
As part of the interview process candidates may be required to complete compliance policy knowledge with business impact analysis.
Knowledge of Medicare Advantage, Commercial, and ACA plan-specific UM compliance requirements (CMS, NCQA, FL Statutes)

Mansioni

Serve as a liaison between internal clients and functional departments; help clients achieve their objectives by serving as a resource in the interpretation, application and compliance with internal and external laws, regulations, policies, procedures, standards and practices.
Identify risks, evaluate controls and prepare findings and recommendations. Implement compliance programs to prevent illegal, unethical or improper business practices.
Monitor and evaluate the effectiveness of solutions, policies, practices and processes to ensure continuous improvement, good client relations and adherence to business requirements. Recommend improvements to achieve and deliver high quality, value-added services.
Develop, implement, administer and revise policies, procedures and programs that meet business needs; assist and/or lead program development and enhancements.
Research, analyze, maintain, modify, validate and prepare data, information and content used in making business decisions. Present findings and articulate results.
Produce, edit and distribute a variety of business documents such as reports, proposals, policies, procedures, audit results, issue papers, marketing materials, newsletters, brochures, etc.
Create, present and/or facilitate meetings, webinars, conference calls, training programs, education sessions, certifications, etc. for a variety of internal and external audiences.
Represent assigned function at external hearings, mediations, audits, meetings, etc.
Participate on or lead large, complex departmental and/or divisional projects. Plan, organize, monitor and control projects to ensure the effective use of resources and adherence to project management standards and reporting requirements.
Participate on Company workgroups and initiatives.
Develop and build internal and external partnerships to improve communication, coordination, collaboration and effective working relationships within own department, across the Company and outside of the Company.
Mentor and coach less experienced coworkers on the technical and interpersonal skills needed for effective job performance.
Provide support to Florida Blue's Utilization Management (UM) department by ensuring adherence to Centers for Medicare and Medicaid Services (CMS) requirements and National Quality Care Assessment (NCQA) accreditation standards.