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SelectHealth currently has two openings on for a Compliance Consultant Associate on the Medicare Advantage team. This role identifies new and existing Federal laws, regulations, rules and bulletins applicable to SelectHealth's Medicare Advantage business. This position demonstrates an understanding of the regulations that govern Medicare Advantage and works to ensure compliance with those regulations. This position investigates issues and works with others to resolve those issues, provides education and information, assesses risks, and monitors outcomes. The compliance consultants are typically assigned to work in a specific area of focus such as pharmacy, claims, enrollment, etc.
Essential Job Duties
1. Maintains a broad working knowledge in health care regulations and understanding of health care regulations, rules and bulletins applicable to SelectHealth and how they affect Medicare Advantage membership.
2. Assists in coordinating the determination of regulation impact to business with appropriate departments. Educates staff regarding regulations affecting SelectHealth’s Medicare Advantage population and evaluates operational processes to ensure compliance.
3. Coordinates across disciplines to ensure that stakeholders are involved in the early planning stages and implementation of federal and other regulatory requirements for changes in documentation and work flow processes.
4. May work with various departments and functions within SelectHealth to identify and resolve issues and create options for compliance implementation.
5. Participates in assessing and mitigating risk. Assists in the remediation of acute and chronic issues reported to Compliance to decrease risk.
6. Serves as a subject matter expert and resource to others and may act as an advisor for the compliance department.
7. Participates in, and analyzes the results of internal and external compliance audits, and utilizes this information to focus on education and implementation of corrective action plans to improve overall processes and documentation accuracy throughout the system
8. Manages projects and oversees programs that overlap between several operational or business areas, ensuring that processes are efficient.
10. Assists in developing quality improvement plans.
11. Conducts training sessions and audits of operational areas to assess and improve understanding of compliance provisions applicable to operational areas by staff, and tests procedures to ensure compliance with those provisions.
12. Assists departments in creating and reviewing policies, procedures, and protocols..
- Entry Rate: Commensurate with experience
- Benefits Eligible: Yes
- Shift Details: Full-time, Exempt
- Department: SelectHealth - Compliance (Medicare Advantage team)
- Bachelor's Degree. Degree must be obtained through an accredited institution. Education is verified.
or Five years of professional experience working in compliance related roles.
- Four years of experience working in healthcare, operations, legal, insurance or regulatory-related roles requiring effective problem solving and analytical skills.
- Experience managing projects that require strong interpersonal and organizational skills and the ability to perform under stress and to meet deadlines.
- Experience in a role requiring knowledge of, and experience with, health care regulations.
- Experience in a role requiring the demonstrated ability to effectively and confidentiality advise and interact with all levels of personnel as well as experience dealing with highly sensitive and confidential material and adhering to data security and confidentiality protocols and procedures.
- Experience using word processing, spreadsheet, database, internet and e-mail and scheduling applications.
- Experience in a role requiring effective verbal, written and interpersonal communication skills.
- Ability to travel to Intermountain facilities throughout the state on occasion.
- Interact with others requiring the employee to communicate information.
- Operate computers and other office equipment requiring the ability to move fingers and hands.
- See and read computer monitors and documents.
- Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
- SelectHealth or other health plan experience
- Compliance Certification (e.g. CHC)
- Experience training others
- Professional writing experience including writing reports, summaries, and arguments for various audiences
- Experience in researching and interpreting statutory and regulatory requirements
All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.