Compliance Specialist

Independent Health•Buffalo, NY

4d•$30 - $35

About The Position

The Compliance Specialist will be responsible for the coordination of all complaints received through various methods, to be reviewed, investigated and draft responses prepared, and to facilitate approval and response submission in accordance with required timeframes. The Specialist will assist with the compliance activities related to PBD’s accreditations, certifications, licenses, and regulatory requirements (e.g., URAC PBM accreditation, regulatory and utilization review licenses). The Specialist will assist with compliance and regulatory audit activities, corrective action plans, market conduct exams, and compliance submissions.

Requirements

High school diploma or GED required. Associates degree preferred.
Three (3) years of compliance, legal, quality assurance/audit or healthcare operations required.
Prior experience in complaints or compliance preferred.
Experience in the creation or review of policies, procedures, and reports and ability to assess controls needed to meet requirements, render decisions and troubleshoot issues.
Proficient in performing work that requires knowledge of compliance and legal concepts, with emphasis on corporate, business law, or compliance as well as other areas of general practice.
Strong critical thinking, analytical, problem solving, time management and organizational skills
Strong interpersonal skills with the ability to interact with internal and external clients and vendors.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

Associates degree preferred.
Prior experience in complaints or compliance preferred.

Responsibilities

Ensure thorough research is completed to determine if all necessary information is received and obtained from internal systems.
Create communication documents and letters to external customers, including but not limited to regulatory agencies, in accordance with the organizational processes and regulations. This will include but is not limited to requesting medical records, invoices, and acknowledgement letters.
Ensure verbal and written correspondence regarding complaints and regulatory investigations are in compliance with regulatory standards and work is prioritized based on expediency.
Ensure that all outgoing communications are HIPAA compliant and sent to the correct parties.
Coordinate and complete requests by prioritizing and monitoring them to ensure timely turn-around.
Knowledge of program standards, regulations and legislation to aid in the development and implementation of processes and documentation necessary for accreditation, certification, registration and licensing.
Assist project teams performing necessary preparation activities for accreditation, certification, registration and licensing submissions and mid-cycle audits and renewals; including but not limited to gathering requested information, updating, and reviewing documentation for accuracy and other activities as deemed necessary.
Assist with monitoring and evaluating programs and operations compliance with accreditation standards and any state or federal regulatory requirements as necessary.
Support program requirements, meetings, note taking and dashboard maintenance for the Quality Management Committee.
Support the organizational policy and procedure process to ensure all functional areas are maintaining documentation.
Assist in monitoring and compliance with accreditations, requirements, policies, and procedures to ensure adherence and provide prompt reporting of instances of actual or potential non-compliance, including remediation efforts for instances of non-compliance.