No more applications are being accepted for this job
- Manage the day-to-day operation of the HRI Compliance and Delegation Oversight Program.
- Identify potential areas of non-compliance, FWA issues, areas of potential risk, potential strategic advancements, and regulatory changes, and develop and implement corresponding action plans including but not limited to reporting any areas of excessive risk directly to the Board of Directors.
- Coordinate responses to government investigations and other inquiries or demands.
- Identify, investigate, and provide necessary reporting of violations/potential violations of rules, regulations, policies, procedures, and standards of conduct to leadership and/or regulatory agencies
- Monitor proposed federal and state regulatory and policy changes and identify potential risks to the organization. Represent HRI with various state and federal trade organizations.
- Research and provide guidance on federal and state health care program statutes, regulations, rules, and guidance regarding reimbursement, conditions of payments, new offerings, coverage, and other material requirements.
- Research and prepare responses to complaints (provider and/or member) filed with the state Departments of Insurance, attorney generals' offices, Health and Human Services, and other state and federal administrative entities; identify trends/findings with significant policy/operational impact and address same.
- Proactively assess risks and execute the Compliance Plan, resulting in timely deliverables, and resolving and communicating issues/problems.
- Lead HRI's response to privacy and confidentiality concerns, authorization requirements, and informational notices and materials reflecting appropriate regulatory practices.
- Develop department-specific compliance training and education, as needed.
- Respond to Health Plan Partner Sponsor inquiries as needed.
- Chair the Health Resources, Inc. Compliance Committee and participate in various operational committees to ensure risk mitigation.
- Manage Company Compliance calendar ensuring all regulatory timelines are met.
- Manage Company Plan Filings process and monitor utilization of only filed products.
- Work in conjunction with the Legal and Compliance departments to assist with corporate regulatory requirements.
- Develop, initiate, maintain, enforce, and revise departmental policies and procedures; maintain all corporate policies.
- Additional duties as assigned.
- Related supervisory/managerial experience and the ability to establish a structure of communication and teamwork.
- Experience with Federally-Facilitated Health Insurance Marketplace regulations, privacy, and security rules established under the Health Insurance Portability and Accountability Act (HIPAA), and state laws and regulations concerning insurance and third-party administrators.
- Demonstrated technical knowledge of dental insurance, and government programs compliance/regulatory matters.
- Excellent verbal and written communication skills including the ability to communicate complex regulatory guidelines to all levels of the organization.
- Ability to plan, coordinate, and organize multiple priorities with minimal supervision.
- Proficient in using Microsoft Office programs, particularly Excel, Word, and PowerPoint.
Dental Compliance Officer - Toledo, United States - ProMedica
Description
Paramount Health Care, a ProMedica Health Plan, offers insurance products across six Midwest states. This Ohio-based company, headquartered in Toledo, has more than 685 employees dedicated to serving their health plan members.Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers' compensation, as well as vocational rehabilitation, life-care planning and wellness.
REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES
Reports directly to the President, Health Resources, Inc.
POSITION SUMMARY
This position is responsible for assessing potential risks and directing, developing, and coordinating programs, policies, and procedures to ensure HRI's compliance with federal, state, and local laws and regulatory requirements.
ACCOUNTABILITIES
REQUIRED QUALIFICATIONS
Education:
Bachelor's Degree in Business Administration, Law, or a related field
Skills:
Years of Experience:
Minimum of eight years of legal or compliance experience and state or federal regulatory or managed care compliance experience.
License:
N/A
Certification:
N/A
PREFERRED QUALIFICATIONS
Education:
Juris Doctor degree and a license to practice law in the relevant jurisdiction.
Skills:
N/A
Years of Experience:
Minimum of ten years of legal or compliance experience and state or federal regulatory or managed care compliance experience.
License:
N/A
Certification:
N/A
WORKING CONDITIONS
Personal Protective Equipment:
N/A
Physical Demands:
Must be able to move between offices and workstations and occasionally lift lightweight materials.
Travel:
This position may be required to travel occasionally between Evansville, Indiana and Toledo, Ohio.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category.
Equal Opportunity Employer/Drug-Free Workplace
Employee Exemption Type
Exempt
Job Type
Full Time
Budgeted Hours / Pay Period
80
Shift Type
Days
Shift Hours
8 hours
Weekends
On-call Requirements
Additional Schedule Details