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Compliance Specialist

    • Job Tracking ID: 512689-605030
    • Job Location: Milwaukee, WI
    • Job Level: Mid Career (2+ years)
    • Level of Education: BA/BS
    • Job Type: Full-Time/Regular
    • Date Updated: January 15, 2018
    • Years of Experience: 2 - 5 Years
    • Starting Date: ASAP
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Job Description:

This position assists the Director of Compliance with the implementation and oversight of the compliance program at iCare. This includes: external reporting and internal auditing of iCare’s compliance with federal, state, and local laws, and regulations; contract requirements applicable to iCare’s business as a licensed health maintenance organization; and as a government contractor for the provision of health care benefits.

  1. Develop and implement components of the corporate compliance program (i.e. training programs, policies and procedures, compliance audits and assessments, and communications).
  2. Assess and monitor compliance with requirements of all regulatory agencies.
  3. Coordinate data retrieval, analysis, and submission for support of internal and external audits, certifications, regulatory reporting, and any other regulatory requests. Serve as liaison between company/departments and auditors/regulators as needed.
  4. Evaluate state and federal related compliance activities to determine any changes or specific needs for company compliance.
  5. Conduct investigations to resolve compliance complaints and report violations to the appropriate entities.
  6. Develop and oversee corrective action and quality improvement plans in conjunction with other departments as needed.
  7. Conduct audits related to Medicare and Medicaid Managed care requirements.
  8. Review vendor/contractor/provider compliance with State and federal rules and regulations and act as liaison with same regarding compliance activities and improvement programs.
  9. Fully participate in iCare’s Compliance Program, including compliance with iCare’s Code of Conduct, policies and procedures, and all applicable Privacy and Security Laws.
  10. Participate as needed with other departments on compliance issues.
  11. Participate in Compliance Committee and other related committees as needed.
  12. Conduct compliance training as required.

Experience and Skills:

  1. Bachelor’s Degree in related field.
  2. Understanding of Medicaid/Medicare and/or insurance and managed care lines of business.
  3. 3-5 years experience as a paralegal or similar experience in dealing with insurance and government regulators.
  4. Knowledge and experience in working with statistical data.
  5. Experience analyzing complex business and regulatory issues.
  6. Project management skills and experience.
  7. Excellent written and verbal skills
  8. Ability to work independently and to manage multiple projects within established time frames.

 

 
 
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
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