Compliance - Compliance & Risk Management Specialist 126-2007 at CommunityCare

Tulsa, Oklahoma, United States -

Full Time

Start Date

Immediate

Expiry Date

30 May, 26

Salary

0.0

Posted On

01 Mar, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Regulatory Research, Compliance Program Management, Enterprise Risk Management, Risk Assessment, Risk Mitigation, Data Analysis, Reporting, Governance, Communication, Problem-Solving, Critical Thinking, Process Management, Microsoft Applications

Industry

Insurance

Description

JOB SUMMARY: The Compliance and Risk Management Specialist assists in the ongoing success of CommunityCare’s Compliance program and Enterprise Risk Management (ERM) program. The Specialist will work closely with the VP, Chief Compliance and Risk Officer and communicate effectively with all operational areas of the company by conducting regulatory research and addressing compliance questions or compliance issues that arise throughout the organization. The Specialist will maintain current knowledge of industry best practices for Compliance and Risk Management, specifically as it relates to Federal Government programs such as Medicare and the Affordable Care Act. The Specialist identifies inherent risks and opportunities, documents risk tolerance levels, and reports on the status of ongoing monitoring of key controls in support of CommunityCare’s strategic goals and objectives. Provides consolidated reporting of disparate risks, improves understanding of key risk drivers and performance indicators to drive subsequent decision- making, strengthens organizational governance, and supports a risk intelligent culture throughout the organization. KEY RESPONSIBILITIES: Develops and maintains relationships with process owners and provides support for investigating, researching and addressing compliance questions and instances of non-compliance Responds to day-to-day questions related to compliance issues and conducts regulatory research, as needed, to appropriately respond. Communicates effectively the importance of maintaining corporate compliance and managing risk in day-to-day operations. Works closely with the VP, Chief Compliance & Risk Officer to design and establish ongoing compliance for the Compliance and Enterprise Risk Management programs. Stays abreast of current federal and state laws, rules and regulations regarding health plans, particularly Medicare and Affordable Care Act (ACA) regulations; provides support for the consistent and fair application of such laws, rules and regulations across the organization. Gather organizational performance information and develop or implement risk-assessment models or methodologies. Perform statistical, quantitative and qualitative analysis on individual risks and the risk inventory to identify underlying relationships and assist in the risk roll-up/alignment process. Perform regular monitoring of emerging risks, analyze risk trends, and work with risk owners to analyze complex risks and make potential risk mitigation recommendations Work with management, and staff to facilitate the Enterprise Risk process for risk identification, definition, assessment, analysis, mitigation, and monitoring throughout. Produce reports that outline findings, explain risk positions, and recommend ways to control or reduce risk. Recommend and present findings to senior leadership. Work with Chief Compliance and Risk Officer to ensure effective alignment of the ER process with Internal Audit, Compliance, and company strategy. Regularly educate and communicate key risks to management and employees. Maintain Enterprise Risk framework, policies, procedures, and other associated documentation and updated as appropriate. Complete other duties as assigned by Chief Compliance & Risk Officer. QUALIFICATIONS: Involves frequent contact with individuals inside and outside of the organization requiring tact, discretion, professionalism and confidentiality at all times. Must be able to communicate effectively within all levels within the organization, including executive leadership. Familiarity with established organizational Compliance and ERM processes and frameworks and their practical application within the company. Knowledge of Compliance and Risk Management best practices as they apply to the health care industry and government health plans. Ability to research, assess and interpret regulations and understand regulatory processes and requirements. Strong problem-solving and critical thinking skills and the ability to break down complex concepts. Demonstrated ability to lead workgroups and manage processes in a cross-functional environment. Ability to work independently with minimal supervision and proven ability to manage multiple tasks. Ability to take initiative and seek out innovative ideas. Ability to maintain the highest levels of confidentiality and work independently as well as part of a team. Successful completion of Health Care Sanctions background check. Possess strong oral and written communication skills. Proficient in Microsoft applications. EDUCATION/EXPERIENCE: Bachelor’s degree in Business Administration, Health Care Administration or related field. A minimum of 5 years relevant experience with health care compliance or risk analysis and management is preferred. Health Care Compliance Association (HCCA) certification (CHC) preferred. Experience in Federal government programs such as ACA and Medicare preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Responsibilities

The Specialist supports the Compliance and Enterprise Risk Management programs by conducting regulatory research, addressing compliance questions, and maintaining current knowledge of industry best practices, especially concerning Medicare and the Affordable Care Act. Key duties include developing risk assessment models, monitoring controls, producing risk reports, and facilitating the Enterprise Risk process across the organization.