Job description
Position Summary
This position is hybrid so the candidate must be local to the area and will work onsite the first 30 days for training.
The Compliance Specialist is responsible for supporting the Director of Compliance/Privacy Officer and Chief Compliance Officer in implementing and executing the compliance program within Mom’s Meals. Duties include managing third party audits, privacy, grievance, and critical incident reporting. Successful candidates contribute to a positive culture of compliance at Mom’s Meals.
This position is hybrid so the candidate must be local to the area and will work onsite the first 30 days for training.
Position Responsibilities may include, but not limited to
- Regularly review State and Federal laws, rules, and notify internal business partners of applicable changes to ensure organizational compliance is maintained
- Complete a regular review of policies and procedures to maintain alignment with state and federal compliance regulations
- Develop and maintain audit process for payer/agency audits requested by outside parties both on-site and remote desk audits
- Track and coordinate all internal communication and document retrieval for audits; support internal customers with gathering documentation for credentialing, provider enrollment, contracting, and other requests
- Draft Corrective Action Plans (CAP) and Audit Appeals with appropriate internal customers and Compliance Team in response to audit findings
- Maintain electronic audit resource library to ensure up-to-date documentation
- Identify, track, and trend auditing to ensure proactive preparation for future audits and/or determinations resulting in CAPs
- Investigate Critical Incidents with appropriate internal business partners and notify agency caseworkers/contacts according to contractual and regulatory obligations
- Investigate and respond to Grievances received from clients, agencies, and third parties; provide any required follow-up education to employees or leaders; collaborate with leadership to determine and implement corrective actions
- Perform exclusion checking for new vendors to meet the Office of the Inspector General requirement and reviews any findings; communicate results to business leaders; evaluate unfavorable findings and collaborate with Director for further action
- Participate in trainings and provider meetings required by agencies, health plans, and Managed Care Organizations and disseminate relevant information
- Compile compliance metrics and analyze results for ongoing tracking; report metrics to the Chief Compliance Officer/Director for Board and Executive review
- Manage general compliance email
- Execute regular Compliance Program Self-Assessments based on the Department of Justice recommendations
- Develop and provide employee compliance education including onboarding, annual training, and departmental-specific training; review education annually or as rules and regulations change
- Complete a regular review of policies and procedures to maintain alignment with state and federal privacy regulations
- Review and investigate impermissible use/disclosure reports and completes privacy risk assessments to determine need for internal process change, employee re-education, and/or breach notification as required
- Review and respond to individual requests based on specific state regulations, client requests for information, and third-party request for information within required regulatory timing
- Consult with Information Security Team and outside vendors to complete HITRUST certification/re-certification
- Develop and provide employee privacy education including onboarding, annual training, and departmental-specific training; review education annually or as rules and regulations change
- Act as an internal compliance resource for Mom’s Meals employees
- Engage in ongoing education and professional development to increase compliance expertise, business acumen, and regulatory knowledge
- Collaborate with teammates, leadership team, and internal business partners to produce effective compliance and privacy program outcomes
Required Skills and Experience
- Bachelor’s degree in business or healthcare related field or 4 years relevant experience
- 2+ years' experience in auditing, payer relations, compliance, privacy, information security or other relevant healthcare industry experience
- Strong problem-solving skills to include developing and analyzing options and recommending solutions
- Ability to prioritize (and re-prioritize) projects in a fast-paced work environment
- Effective written and verbal communication skills
- Ability to work collaboratively to foster trust, credibility, and understanding
- Ability to promote teamwork within department and organization
- Effective personal organizational skills to meet deadlines, complete work assignments and projects and/or accomplish time sensitive work prior to due dates
- Maintain working knowledge and understanding of various state/federal compliance and privacy laws, rules and regulations related to Medicare/Medicare Advantage plans, Medicaid, Managed Care Organizations
Preferred Skills and Experience
- Certification in compliance, privacy or other relevant area
Physical Requirements
- Repetitive motions that include the wrists, hands and/or fingers
- Sedentary work that primarily involves sitting, remaining in a stationary position for prolonged periods
- Visual perception to perform job including peripheral vision, depth perception, and the ability to adjust focus
Company Overview
Mom’s Meals is a home-delivered meal service providing fully prepared, refrigerated meal solutions direct to homes nationwide for over 18 years. We provide seniors, patients recovering post-discharge and those managing a chronic condition with tailored nutrition solutions to manage their specific needs. If you are passionate about the well-being of others and have a strong sense of community, Mom’s Meals could be the place for you! We are a family operated business looking for fun, compassionate, and friendly people who want to make a difference in the lives of others.
EEO
Mom’s Meals complies with all applicable federal and state non-discrimination laws. All qualified applicants shall receive consideration for employment without regards to race, religion, national origin, ancestry, color, gender, age, disability, sexual orientation or military status.
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