Compliance Coordinator - Compliance - Full Time - Days

Promedica Maumee , OH 43537

Posted 2 months ago

At Paramount, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA the National Committee for Quality Assurance for our Ohio HMO, Elite and Advantage products. We're also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.

The Compliance team is adding a Compliance Coordinator. The Compliance Coordinator will be responsible for assuring assigned business units have efficiently operationalized regulatory requirements and will assist assigned business units in implementing changes to processes to assure continued compliance with federal and state regulations.

PRINCIPAL ACCOUNTABILITIES

  • Active participation on Paramount Compliance Council.

  • Function as the day-to-day resource for compliance questions and concerns for assigned areas of responsibility, including but not limited to oversight of departmental policies and procedures.

  • Attend department leadership meetings (no less than quarterly). Maintain a standing agenda for these meetings based on agenda item standardization as developed by the Paramount compliance council. For example: Compliance and privacy monitoring metrics, significant trends identified and plans for remediation, address compliance issues and concerns raised by leadership and communicate these back to the Paramount compliance council to ensure issue is addressed at other BUs as well, and industry trends, law/regulation changes and best practice.

  • Monthly analysis of Compliance Monitoring data and other metrics for issues and trends. Evaluate compliance with governmental and other regulations. Work with individual department heads when data indicates inadequate compliance to assist in action plan development and resolution.

  • Initiate and direct the conduct of internal and external investigations in response to reports of possible compliance violations, state and federal regulator queries, and/or complaints filed by enrollees/providers with state and/or federal regulators.

  • Facilitate, as appropriate, corrective actions as a result of internal investigation with all departments, providers, and employees.

  • Assist in establishing methods to improve the efficiency and quality of services and in reducing vulnerability to fraud, abuse, and waste.

  • Assist in the assessment of department specific learning needs and knowledge gaps using both internal resources (i.e. audit and/or investigation results, data analysis, reported deficiencies) and industry identified high risk areas. Assist in the development of department specific compliance training/education. Provide educational material to the Management team regarding new laws and regulations and issues affecting their specific areas of practice.

Job Requirements

REQUIRED QUALIFICATIONS

Education: Bachelor's Degree in Business Administration, Law or related health care field.

Years of Experience: Three (3) years audit, legal or compliance experience in a health care setting or managed care organization. Familiarity with health care operations and health care regulatory environment.

PREFERRED QUALIFICATIONS

Education: Master's Degree in Business Administration, Law or related healthcare field.

Skills:
LEAN and/or Six Sigma training.

ADDITIONAL EXPERIENCE

  • Must be highly ethical, and able to maintain strict confidentiality.

  • Expected to uphold and communicate the principles of the Compliance plan at all times.

  • Have the ability to collect, analyze and summarize data from a variety of sources is essential to this position.

  • Have superior verbal and written communication skills, including the ability to clearly communicate complex regulatory guidelines and coordinate communication among groups.

  • Be able to establish a structure of communication and teamwork with the BU/Department leadership.

  • Be able to understand directions and respond to inquiries; must have excellent interpersonal skills and ability to work with people at all levels of the organization.

  • Be able to move about business offices and between work stations.

  • Be fully proficient with Microsoft Office products including Word, Excel and Power Point.

  • Be able to occasionally move lightweight materials.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. It serves communities in 30 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 70,000 employees, 13 hospitals, 2,700 physicians and advanced practice providers with privileges, 900+ healthcare providers employed by ProMedica Physicians, a health plan, and 450 assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace

Employee Exemption Type

Exempt

Job Type

Full-time

Budgeted Hours / Pay Period
80

Shift Type

Days

Shift Hours

Weekends

On-call Requirements

Additional Schedule Details


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Compliance Coordinator - Compliance - Full Time - Days

Promedica