Compliance Specialist – DOCTORS HEALTHCARE PLANS, INC. – Coral Gables, FL

Job title: Compliance Specialist Company: DOCTORS HEALTHCARE PLANS, INC. Job description: Job description Position Purpose: Responsible for auditing and monitoring, data collection, analysis and mapping of business processes to ensure compliance and gauge performance against regulatory requirements and established standards. Responsibilities:

• Developing and maintaining Compliance Dashboard.
• Audits, monitors and provides training and clarification of Medicare requirements and other general processes (may include delegates).
• Organizing, tracking and data entry of report(s), monitoring and auditing of submitted data including maintaining audit results and monthly reporting that tracks and compares compliance patterns.
• Works closely with departments and/or delegated entities and communicates audit schedules and audit results to departments and/or the delegated entities.
• Assists in the preparation and planning of the upcoming new years audits to include scheduling and management of future audit dates and the updating of department references and tracking logs.
• Supports internal and external department requests for data as it relates to compliance and delegation oversight including but not limited to regulatory and internal control audits, various committee reports and information to support the Legal Departments responses to state agencies.
• Obtains, organizes and tracks internal information and delegated entities data report submissions for compliance purposes but not limited to tracking, trending, and communicating to assure data can be compared for trends and noncompliance. Presents summary of all tracking reports to management, auditors, and other internal departments upon request, on a monthly basis and identifies areas of delinquency.
• Responsible for communicating effectively internally and with delegated entities with respect to notification of audit, including requesting of universes, communicating audit results and any follow-up Corrective Action Plan letter notifications.
• Works with internal departments and delegation oversight leadership to maintain audit files (both paper and electronic) including development of online folders for oversight audits and corresponding data, requesting offsite storage, shredding when deemed appropriate and assisting in preparation of audit files/cases for regulatory audits.
• Other duties as assigned.

QUALIFICATIONS:

• Bachelor's degree or equivalent work experience;
• Minimum 3-5 years prior Medicare managed care experience preferably in compliance and/or quality management experience with comprehensive knowledge and understanding of CMS, NCQA or AAAHC and URAC Credentialing, Delegation and Quality Improvement;
• Prior work experience with conducting audits and understanding of auditing methodologies;
• Business analytical skills: process flows, spreadsheets, modeling, procedures, etc.;
• Strong knowledge of MS Office, including Access, Project, Excel, Visio;
• Effective verbal and written communication skills; and ability to multi-task in a fast-paced, team-oriented environment.

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member. No Third Party Agencies or Submissions Will Be Accepted. Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein. Powered by JazzHR Expected salary: Location: Coral Gables, FL Job date: Thu, 01 Sep 2022 07:29:44 GMT Apply for the job now! Apply tot his job Apply To this Job