Compliance Specialist

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.

• 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.