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Delta Dental of Michigan · 3 days ago

Compliance Specialist

Okemos, MI

Full-time

Hybrid

Mid Level

3+ years exp

Delta Dental of Michigan is one of the largest dental plan administrators in the country, dedicated to improving oral health through benefit plans and community support. The Compliance Specialist will manage the Compliance Program and ensure adherence to regulatory requirements while facilitating training and communication across the organization.

Health Care

Responsibilities

Implements initiatives to raise awareness of Company’s Compliance Program including planning, developing and conducting education and training activities related to compliance

Responsible for the development of training materials, implementation of training calendar, monitoring and auditing employee training records

Monitors and evaluates documents to determine the relevance of regulatory updates that may affect member materials

Responsible for monitoring document revision processes, ensuring that changes are implemented from initial request through approval by internal and external parties and verifying the accuracy of final production

Provides consistent updates to management and relevant stakeholders on the status of document implementation and highlights any risks related to timely and accurate implementation

Manages and maintains a document repository of member and provider documents, to ensure that forms are consistent with company standards, and legal, contractual and regulatory requirements

Responsible for working with internal and external stakeholders to ensure work is prioritized and implemented by the required deadline

Acts as a liaison for the compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions, rules and regulations, including the assessment, interpretation and drafting of policy, procedure or job aids

Advises organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them

Facilitates and manages coordination between compliance department and operations on new compliance efforts and initiatives

Plays a key role in the annual compliance risk assessment and collaborate to ensure proper auditing is conducted and management of identified risks is appropriate

Maintains and analyzes company’s monitored compliance efforts and identify and assess gaps

Coordinates various committees and task forces related to company’s compliance, including management of assignments

Facilitates and coordinates all aspects of any Medicare Advantage, Medicaid or Affordable Care Act audit, request, or inquiry by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaborating with the applicable operational subject matter expert that may be required as a result of the request

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above

Qualification

Compliance experienceHealth insurance knowledgeRegulatory knowledgeCompliance certificationAnalytical skillsInterpersonal skillsCommunication skillsOrganizational skillsAttention to detailAdaptability

Required

Position requires a bachelor's degree in business administration, health administration, public health/public policy or a related field

Three years of compliance experience, preferably in the health insurance industry or five years' experience related to auditing, quality monitoring, risk management, or operations

Capability to process substantial amounts of detailed information with a high degree of accuracy

Ability to demonstrate strong analytical skills

Efficiently manage multiple projects and effectively analyze data to develop alternative solutions

Excellent interpersonal, verbal, and written communication skills

Strong attention to detail and adaptability to shifting priorities and deadlines

Strong organizational skills and proficiency in handling competing demands

Ability to work independently and collaboratively within a fast-paced team environment