Genex Services · 1 week ago
Compliance Specialist 2
United States
Full-time
Remote
Entry, Mid Level
$53K/yr - $82K/yr
2+ years exp
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Hiring Manager
Frankie Pham
Insider Connection @Genex Services
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Responsibilities
Maintain regulatory filings for UR department.
Responsible for internal and external audits (URAC, State, and Client).
Monitor Compliance changes and work with operations team and clients to determine impacts.
Interact with clients to discuss regulatory and compliance matters.
Maintain client Informational documents.
Gathers and documents evidence of task and project completion.
Ensures UR Compliance documents and records are maintained with accuracy and in compliance with good documentation practices and record retention requirements.
Assist with preparation and response to time sensitive state and client audits by gathering necessary documentation from multiple platforms.
Timely submission of completed audit log and files to appropriate party.
Gathers and compiles information for regulatory reports.
Draft, coordinate review, and submit regulatory reports.
Documenting and tracking of all licensing requirements and application statuses.
Work with internal departments for the timely completion and submission of licensing requirements.
Provide support in developing, implementing, monitoring and updating quality improvement and utilization management initiatives.
Support quality improvement initiatives, including but not limited to: monitoring, auditing, and tracking of Utilization Management Program.
Coordinate with other departments and assist as needed in performing/monitoring required UM internal audits.
Collaborating with management to develop quality assurance plans, working with employees to implement strategies, and reviewing documents for accuracy.
Qualification
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Required
Bachelor Degree.
2 years of experience in compliance, regulatory, or quality assurance or a minimum of two years’ utilization management experience.
Demonstrated experience utilizing Word, PowerPoint, Excel and other similar software for a variety of information reports and project tracking.
Requires practical knowledge and demonstrated competence within job area typically obtained through advanced education combined with experience.
Familiar with policy review, report development/gathering to support URAC accreditations.
Knowledge of Utilization Management clinical reviews.
Experience in organization, tracking, and trending of information.
Exposure with Utilization Management Licenses (Nationwide).
Experience with internal auditing.
Preferred
Bonus: Clinical background such as case managers, registered nurse, initial clinical reviewer or clinical peer reviewer.
Benefits
Medical
Dental
Vision
Health Savings Accounts / Flexible Spending Accounts
Life and AD&D Insurance
401(k)
Tuition Reimbursement
Company
Genex Services
Genex Services provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled employees.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknown2018-02-09Acquired
Leadership Team
Peter C Madeja
President and Chief Executive Officer
Debbi Bromley
Senior Vice President, Human Resources
Company data provided by crunchbase
