Compliance Coordinator

Job Description

Job Description

JOB DESCRIPTION

JOB TITLE: Compliance Coordinator FLSA STATUS: Non-Exempt

DEPARTMENT: Compliance

REPORTS TO: Compliance Officer

JOB SUMMARY: Primary responsibility for providing administrative support to the Compliance Officer and other staff within the Compliance Department as applicable with daily compliance functions. Coordinator supports the Compliance team with the management and implementation of the Compliance program. Coordinator will also serve as the department liaison regarding day-to-day compliance related activities for internal and external inquiries.

ESSENTIAL JOB FUNCTIONS:

1. Direct administrative support to the Compliance department as it relates to daily compliance functions.
2. Conduct weekly employee onboarding training as it relates to Compliance items.
3. Distribution/documentation for the Compliance training including Compliance testing.
4. Work with Human Resources on obtaining OIG/SAM checks upon hire and annually thereafter.
5. Conduct HIPAA walkthroughs documenting and identify privacy breaches as well as maintain reporting of privacy issues.
6. Maintain Company contact information.
7. Create all department meeting notes, agendas, minutes, and corresponding documents.
8. Support the monitoring oversight activities of the department through document coordination, review, analysis, and reporting.
9. Provide Administrative support for audits with coordination of ongoing audits of each functional area’s compliance with all applicable CMS guidelines.
10. Responsible for collecting, tracking, monitoring and review of regulatory reporting requirements to ensure that reports are submitted timely and accurately (e.g. required Centers for Medicare & Medicaid Services (CMS)/Department of Managed Health Care (DMHC) Part C and Part D monthly/quarterly reports).
11. Stays abreast of changes to federal and state laws and regulations affecting the management, operations, and production offerings of the company. Continually develop subject matter expertise across all operation areas. Ensure questions/issues that may arise are addressed timely and seek subject matter expertise from direct report, where applicable, in order to ensure responses are accurate.
12. Track, and monitor the receipt of all CMS complaints. Responsible for providing daily CTM updates to CMS. In addition to CTM resolution to CMS, addressing any issues that may arise and maintaining tracking of all CTM activity daily and CTM root cause.
13. Maintain the CMS Memo Tracking Log to ensure that all CMS HPM memos, Part D Help Desk and all electronic notification from CMS are tracked and coordinated between departments to ensure compliance.
14. Support the design, development, implementation, and continued maintenance of the plan’s website.
15. Develop and maintain a positive business relationship with all internal and external customers such as CMS, DMHC, IPAs, Supplemental vendors etc. where applicable.
16. Create, update and coordinate policy review and approval as well as storage of such materials.
17. Assist with coordination of all documents related to plan filings and audits. Serve as back up for audits.
18. Assistance member material preparation including but not limited to annual documents (e.g. Annual Notice of Change, Evidence of Coverage, Provider Directory, Pharmacy Directory, Drug Formulary, Summary of Benefits, Pre-Enrollment Kits).
19. Adheres to payroll policies and properly uses timekeeping system with minimal manual changes.
20. Maintains regular and consistent attendance.
21. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.
2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety

a. Reports issues of security, health and/or safety to appropriate supervisor as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• High school graduate or equivalent.
• Healthcare administration related experience required.
• Regulatory Compliance experience preferred.
• 2 years compliance experience or in lieu, two years working with CMS government program, including working knowledge of MAPD plan organization and structure

SKILLS/KNOWLEDGE/ABILITY:

• Knowledgeable of CMS and State regulatory guidelines related to job functionality.
• Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
• Willingness and ability to follow written and verbal direction in English.
• Willingness and ability to maintain appropriate level of confidentiality and privacy.
• Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
• Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
• Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
• Ability to effectively prioritize items/tasks as required.
• Willingness and ability to take initiative and be a self-starter.
• Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

• n/a