Lead Compliance Specialist, Medicaid - Remote

Summary of Job

Partner with functional departments/vendors/delegates to ensure they are in full compliance with all actionable and informational regulatory notices. Identify new and revised regulatory guidance; create paths of communication to business units. Ensure that business areas have implemented regulatory requirements, by collecting artifacts that demonstrate that process, operations, trainings, policies, and procedures have been updated. Provide subject matter expertise and guidance for assigned business areas as it relates to day-to-day needs, including but not limited to, implementations and corrective action plans. Manage projects as needed.

Responsibilities

• Conduct regulatory research to address compliance inquiries.
• Provide regulatory guidance and support for business process improvement efforts.
• Communicate with business leadership regarding events, training, and processes related to regulatory compliance initiatives and/or memos.
• Conduct monitoring and auditing of assigned business areas.
• Ensure that business areas/ delegates understand and address all actionable memos or directives and upload proof of implementation to centralized Compliance Department repository.
• Update and maintain centralized Compliance Department repository records as necessary and appropriate.
• Support external audits or regulatory requests as needed.
• Provide business areas with regulatory guidance to address and mitigate performance or monitoring gaps while ensuring regulatory requirements are met.
• Support business areas in creating and updating P&Ps, trainings, reports, monitoring activities and any project related function to ensuring compliance with regulatory memos and audits by internal stakeholders, vendors, and delegates.
• Contribute to Compliance Department committee and subcommittee materials as needed.

Qualifications

• Bachelor's degree (Required)
• Advanced degree (MPH, MHA, JD and/or MBA) and/or professional certification (Preferred)
• 5 - 8+ years' work experience in regulatory healthcare operations compliance (Required)
• Thorough knowledge of State and/or Federal programs operations and regulations (Required)
• Proficiency in the use of Microsoft Office - Word, Excel, Access, PowerPoint, Outlook, Teams, etc. (Required)
• Strong organizing, prioritizing, analytical, and problem-solving skills; and outstanding attention to details (Required)
• Proven ability to establish and maintain relationships of trust with departmental staff and management (Required)
• Proven ability to coordinate and lead interdepartmental work teams and meet established goals (Required)
• Must be goal oriented and able to meet tight deadlines while handling multiple priorities (Required)
• Must be a team player and able to take direction from multiple sources (Required)
• Proven ability to effectively manage multiple tasks/projects with competing priority levels/deadlines (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
• Ability to arrange work schedule to meet deadlines from multiple sources and engage staff throughout EmblemHealth to assist in the completion of duties (Required)

Additional Information

• Requisition ID: 1000003225
• Hiring Range: $77,760-$149,040