Claims Compliance Coordinator

Compliance Coordinator

HealthPartners is hiring for a Compliance Coordinator in our Riverview Government Program Claims department. This position is responsible for ensuring that the department meets its regulatory requirements, including the day-to-day aspects of either the Membership Accounting or Claims Department by serving as the main contact for monitoring and auditing. The goal of this position is to ensure efficient operational compliance with program policy and standards. This person must be proactive and anticipate potential operational or policy problems, report to leadership team, and take steps to prevent or reduce potential adverse results for the program or its participants. The position will be responsible for coordinating internal reviews, external reviews and audits of products administered by Membership Accounting or the Claims department. The Coordinator also will be assigned ongoing responsibility and accountability for certain department functions and will assist the department leaders as assigned.

MINIMUM QUALIFICATIONS:

• Bachelor's degree or equivalent experience
• Minimum of three years of experience working in a healthcare or business environment

PREFERRED QUALIFICATIONS:

• Direct work experience with regulatory matters.

ESSENTIAL DUTIES:

Compliance 50%

• Reviews contract and regulatory requirements and disseminates information to appropriate team members. Leads implementation as necessary within required timeframes.
• Maintains a tracking system for monitoring contract & regulatory requirements that impact Membership Accounting or Claims.
• Resource for regulatory interpretation questions for Membership Accounting or Claims.
• Consults Government Programs, Product Management, Law and the Internal Audit Department regarding questions related to compliance.
• Participates in decision making and policy setting for Monitoring and Compliance activities and initiative
• Proactively identifies issues and works with partnering departments to develop appropriate corrective action plans for identified issues. Maintains files and documentation of monitoring activities and any resulting corrective action.
• Support system enhancements, training development, data collection, and audit readiness to ensure operational accuracy, compliance, and continuous improvement.

External Reviews & Audits 25%

• Coordinate external reviews and audits of Membership Accounting or Claims products including:
• Prepares and organizes documentation for audits, including work plans, manuals, site visit preparations, and universes.
• Manages documentation as required for post-audit follow-up activities.
• Develops and maintains positive working relationships with internal partners.
• Responsible for collecting and organizing data required for employer audits and Requests for Proposals (RFPs), ensuring information is accurate, timely, and well-documented.
• Serve as the primary point of contact during audits and must be able to respond confidently and effectively to auditor inquiries in a high?pressure environment. The individual will maintain and update the knowledge database, ensuring content remains current, accessible, and aligned with system and process changes.
• Represents Membership Accounting or Claims on internal and external committees as designated.

Reporting & Recordkeeping 25%

• Responsible for Part D Reporting for Membership Accounting or Claims.
• Coordinates the updating and ongoing testing of the Department business continuity and disaster recovery planning and preparation.
• Responsible for implementation and oversight of the records retention process for Membership Accounting or Claims.
• Other duties and responsibilities as needed.

ORGANIZATIONAL EXPECTATIONS:

Values

All colleagues are expected to live our values:

Excellence: We strive for the best results and always look for ways to improve.

Compassion: We care and show empathy and respect for each person.

Partnership: We are strongest when we work together and with those we serve.

Integrity: We are open and honest, and we keep our commitments.

Additional Expectations:

• Complies with safety instructions, observe safe work practices, provides input on safety issues, and promotes a safe work environment.
• Maintains regular and timely attendance.
• Protects confidentiality.
• Demonstrates participation in and support of the organization's Corporate Integrity Program by participating in compliance-related education and training and complying with the organization's policies and procedures.
• Timely completion of all mandatory education and organizational requirements (i.e., licensure/certification, Employee Health and Wellness requirements, annual training, etc.)