Responsible for the development and oversight of the national compliance program for dedicated business unit(s). Direct the compliance activities as they relate to compliance with new and existing laws. Advise and make recommendations to the corporate compliance department. Oversee legal/regulatory compliance (including HIPAA, CMS and other federal compliance requirements) for business and clinical functional areas in all states where business unit(s) is operating. Advise on compliance issues for potential new business including HIPAA, CMS and other federal compliance requirements.
- In collaboration with Corporate Compliance, implements and manages the national compliance program for the business unit(s) operations. Educate management team and staff regarding compliance and the appropriate details of the compliance program.
- Directs federally mandated legal/regulatory compliance activities.
- Serves as a liaison for customers on legal/regulatory issues.
- Generates periodic reports documenting compliance status.
- Ensures corrective actions are implemented for all known compliance deficiencies.
- Submits reports to the corporate Compliance Department.
- Maintains expertise related to authorization/non-authorization correspondence requirements from the perspective of ERISA, federal regulations, and state law.
- Notifies policy content experts of changes to standard policies, and working with IT regarding system changes as it relates to correspondence.
- Oversees the process for applicable state and other licensure as necessary.
- Works with Compliance Attorneys, Compliance Directors, operational staff and Compliance Officer in implementing federal and state laws and regulations.
- Provides education to management and staff regarding the compliance program and HIPAA.
- Serves as central contact for internal and external customers regarding compliance, security, HIPAA, and anti-fraud efforts.
- Tracks HIPAA related activities and ensure appropriate mediation plans are developed.
- Supports internal and external audits and reporting.
- Serves as central contact for all record and subpoena requests.
- Maintains spreadsheet for all requests.
- Collaborates with the compliance and legal department in managing the requests.
General Job Information
- Experience working for a managed care company or other health related organization, strongly preferred.
- An individual who is able to work independently.
- Strong interpersonal, organizational, research and writing skills; attention to detail.
- Ability to coordinate and integrate information from diverse operational areas into a written product.
- Excellent verbal and written communication skills.
- 8+ years of experience with at least 5 of those years in healthcare or managed care/ compliance experience.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.
Job posted: 2020-07-20