New Directions Behavioral Health Compliance Specialist II in NONE, Missouri
The Compliance Specialist II serves as an in-house subject matter expert with respect to regulatory matters pertaining to Medicare and/or health plan compliance operations. Will provide internal stakeholders direction on compliance issues and ensure proper enforcement of compliance standards. Responsible for ensuring compliance with governmental and internal requirements. Assists in the development and implementation of compliance policies and procedures. Performs compliance audits with limited guidance. Assists with the research of compliance issues and recommends changes that assure compliance with contract obligations. Maintains relationships with business owners. Assists with the coordination of site visits for regulators and clients. Assists with the coordination and implementation of compliance with corrective action plans, as needed. Assists with the development, approval, implementation, and coordination of the New Directions fraud protection and prevention programs.
• Be knowledgeable of Medicare Advantage rules, regulations and guidelines and partner with operational areas for proper interpretation and execution.
• Responsible for performing audits and making recommendations to ensure compliance with governmental and internal requirements under the guidance of the Compliance Officer.
• Assists the Compliance Officer to respond to audits from CMS and other third parties.
• Identifies compliance gaps, weaknesses and deficiencies and assists with process improvement and efficiency opportunities.
• Assists the Compliance Officer in monitoring key performance indicators to assess operational risks.
• Remains aware of industry changes and/or trends.
• Monitors and tracks changes for relevant CMS requirements and works with operational area(s) to identify changes to current procedures.
• Evaluates policies and procedures with corresponding desk level procedures to ensure CMS guidance for compliant operational activities remain properly documented.
• Demonstrates solid understanding of operational processes and controls.
• Participates in customer implementations, new operational programs or projects to provide Compliance/ Medicare Compliance input and support.
• Supports communication of audit results in both written reports and verbal discussions with Compliance management and business owners.
• Initiates or supports corrective action plans or continuous improvement plans identified through audits, monitoring departmental performance indicators, or by recommendation of business owner, management or the Board of Managers.
• Follows through on corrective action plans or continuous improvement plans until operational areas meets standards.
• Establishes program governance when needed under the guidance of the Compliance Officer
• Assist with the development of program success measures and performs periodic assessments of program success.
• Edit, write, standardize, research and approve policies and procedures, training manuals and supporting documentation for compliance and other internal departments.
• Handle diverse administrative functions with complex and competing priorities.
• Completes other duties, as assigned.
• Adheres to New Directions Behavioral Health Mission Statement, Core Values, Code of Ethical Business Conduct, and Compliance Program.
• Complies with all Federal and applicable State laws and New Directions Behavioral Health Policies regarding, privacy, confidentiality, and security of health information, and other designated information.
EDUCATION & EXPERIENCE
• Bachelor’s degree or equivalent.
• 3-5 years in compliance, Medicare compliance, Managed Care, audit or as a
• Working knowledge of CMS, Medicare Advantage, Medicare Managed Care
Manual, HIPAA, and other federal and state health care regulatory compliance
• Strong and confident oral and written communication skills.
• Experience with coordinating projects.
• Highly organized, quick learner, detail oriented.
• Works with a professional demeanor under pressure.
• Capable of leading peers to resolve issues and motivate others, including senior
• Enjoys working in teams as well as working on individual assignments.
• Proficient with Microsoft Office (Word, Excel, Power Point and Outlook).
• Master’s Degree or equivalent.
• Experience developing effective relationships with federal and state regulatory
agencies and customers.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.