Description

ABOUT US Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health, and connecting members with community-based resources

POSITION SUMMARY

The Compliance Specialist assists the Compliance Officer with key compliance oversight activities for all departments of the organization to ensure adherence to contractual, legal, and programmatic compliance. This includes: intaking and managing operational responses to regulatory and relevant policy updates; management of regulatory submissions; reviewing and evaluating compliance issues/concerns within the organization and proposing corrective action plans; establishing and revising policies and procedures for the compliance department; conducting internal monitoring activities to ensure compliance with applicable policies and procedures, contractual requirements, and regulations.

ESSENTIAL FUNCTIONS

• Manages all state regulatory and policy transmittals, including the intaking, documenting and responding to changes relevant to the operation.
• Provide compliance support to business leads in support of the operational impact analysis process when responding to policy and/or contractual changes.
• Participate in periodic auditing and monitoring activities with the objective of identifying compliance risks and opportunities for compliance program enhancement.
• Assists with the development of all compliance reports and dashboards aimed at measuring compliance effectiveness and communicating compliance risks to relevant stakeholders.
• Assists with all regulatory report submissions, including providing technical assistance with submission and supporting compliance quality checks.
• Leads development (writing), implementation and upkeep of all compliance policies and procedures
• Assist with the monitoring of the performance of the Compliance Program and related activities on a continuing basis, recommending steps to improve its effectiveness.

Qualifications

• Strong understanding of Compliance regulations and standards
• Strong project management and organizational skills to meet deadlines in an environment of multiple projects and changing priorities.
• Demonstrated analytical, problem solving, and research skills to assess, synthesize, and provide practical solutions to accomplish meaning results.
• Excellent communication (verbal and written) and interpersonal skills and ability to develop collaborative, trusting relationships at all levels of the organization.
• Absolute sense of integrity; will maintain confidentiality and discretion concerning all matters.
• Understanding of compliance and the enforcement environment (with specific attention to HIPAA) and adept at advising on such matters.

EDUCATION AND EXPERIENCE

• Bachelor’s Degree in Related Field of Study or Current Certification in Healthcare Compliance (CHC)
• Strong working knowledge of managed care
• Knowledgeable about applicable federal and state regulatory requirements and guidelines
• A minimum of two (2) years’ experience working in a managed care environment, including experience with regulatory entities and the management of regulatory notices within a managed care setting.

EEO STATEMENT In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions