Compliance Specialist

Delta Dental Plan of Michigan, Inc.; Okemos (MI); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) savings plan

Tuition reimbursement

Volunteer time off

Health coach and personal trainer

Job summary

Delta Dental of Michigan, Ohio, and Indiana is seeking a Compliance Program professional to support the day-to-day operations of the Compliance Program across the organization and its affiliates. You will help implement training, monitor policies, and coordinate with internal stakeholders to ensure regulatory alignment.

The role requires a bachelor's degree and 3+ years of compliance or auditing experience, with Medicare/Medicaid familiarity preferred.

Qualifications

• Bachelor's degree in business administration, health administration, public health/public policy or related field.
• Three years of compliance/regulatory experience; Medicare/Medicaid preferred.
• Strong analytical, communication, and multitasking abilities; detail-oriented.

Responsibilities

• Implements initiatives to raise awareness of the Company's Compliance Program including planning, developing and conducting education and training activities related to compliance.
• Develops training materials, implementation of training calendar, monitoring and auditing employee training records.
• Monitors and evaluates documents to determine the relevance of regulatory updates that may affect member materials.
• Maintains and verifies accuracy of final production and document revision processes.
• Provides updates to management on status of implementation and risks related to timely adherence.
• Coordinates with internal and external stakeholders to ensure work is prioritized and completed by deadlines.
• Advises Compliance Officer on regulatory changes and strategy implementation.
• Facilitates Medicare Advantage, Medicaid, or ACA audits by collecting and verifying required materials.
• Performs related duties to support the Primary Job Responsibilities.

Skills

Analytical skills

Communication

Organizational skills

Education

Bachelor's degree in business administration, health administration, public health/public policy or a related field

Job description

Job Summary

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation. At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do - from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description

To provide support for the day-to-day operations and management of the Compliance Program with respect to Delta Dental of Michigan and its affiliates and/or subsidiaries.

Primary Job Responsibilities

• Implements initiatives to raise awareness of Company's Compliance Program including planning, developing and conducting education and training activities related to compliance.
• Responsible for the development of training materials, implementation of training calendar, monitoring and auditing employee training records.
• Monitors and evaluates documents to determine the relevance of regulatory updates that may affect member materials.
• Responsible for monitoring document revision processes, ensuring that changes are implemented from initial request through approval by internal and external parties and verifying the accuracy of final production.
• Provides consistent updates to management and relevant stakeholders on the status of document implementation and highlights any risks related to timely and accurate implementation.
• Manages and maintains a document repository of member and provider documents, to ensure that forms are consistent with company standards, and legal, contractual and regulatory requirements.
• Responsible for working with internal and external stakeholders to ensure work is prioritized and implemented by the required deadline.
• Acts as a liaison for the compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions, rules and regulations, including the assessment, interpretation and drafting of policy, procedure or job aids.
• Advises organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them.
• Facilitates and manages coordination between compliance department and operations on new compliance efforts and initiatives.
• Plays a key role in the annual compliance risk assessment and collaborate to ensure proper auditing is conducted and management of identified risks is appropriate.
• Maintains and analyzes company's monitored compliance efforts and identify and assess gaps.
• Coordinates various committees and task forces related to company's compliance, including management of assignments.
• Facilitates and coordinates all aspects of any Medicare Advantage, Medicaid or Affordable Care Act audit, request, or inquiry by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaborating with the applicable operational subject matter expert that may be required as a result of the request.
• Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

#LI-Hybrid

Minimum Requirements

Position requires a bachelor's degree in business administration, health administration, public health/public policy or a related field and three years of compliance or regulatory experience, preferably in the health or insurance industry or five years' experience related to auditing, quality monitoring, risk management, or operations. Compliance experience within the Medicare or Medicaid industry preferred. A compliance certification is preferred. Will accept any suitable combination of education, training, or experience. Position requires the capability to process substantial amounts of detailed information with a high degree of accuracy; ability demonstrate strong analytical skills, efficiently manage multiple projects and effectively analyze data to develop alternative solutions; excellent interpersonal, verbal, and written communication skills; strong attention to detail and adaptability to shifting priorities and deadlines; strong organizational skills and proficiency in handling competing demands; and the ability to work independently and collaboratively within a fast-paced team environment.

Company Culture and Benefits

Delta Dental of Michigan, Ohio, and Indiana has been a dental benefits leader for more than 60 years, and today with our affiliates, we are one of the largest dental plan administrators in the country. It's our mission to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by making investments that build healthy, smart, vibrant communities. We celebrate diverse thought and foster a culture where employees go All In - for the company, themselves, their colleagues and their communities. Employees are offered a comprehensive benefits package that includes medical, dental and vision coverage, short- and long-term disability, life insurance, 401(k) savings plans, flexible spending accounts, and tuition reimbursement or educational assistance. Employees are also eligible for annual incentive compensation based on annual business goals. Additionally, employees receive eight hours of paid volunteer time each year, access to an on-staff health coach and personal trainer, plus many other perks. Delta Dental is an Equal Opportunity Employer. The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.