Compliance Specialist Senior
Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.
ABOUT UCAREAt UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities. WORKING AT UCAREWorking at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do. COMPLIANCE SPECIALIST SENIOR Position DescriptionThis position is responsible for conducting audits; providing independent, objective assessments; designing tests to confirm compliance with applicable state and federal laws and regulations, contractual agreements, as well as internal policies and procedures. This position is also responsible for assisting internal departments by identifying where compliance risks may exist; recognizing areas for improvement; and providing recommendations to improve controls and limit potential non-compliance. In addition, prepare reports and analyze in an accurate, comprehensive and timely manner, utilize data analytics to assess compliance trends of key areas. Specific duties and responsibilities include: Assist the Compliance Assistant Director with conducting a comprehensive annual risk assessment used to develop the annual audit and monitoring calendar.Identify and assemble business leads and subject matter experts to participate in internal and delegated entity compliance audits. Develop and communicate the audit plan to relevant internal and external parties. The audit plan includes, but is not limited to objectives, process, scope and timeframe.Review documents pertinent to the audit such as scope documents, case samples, program descriptions, policies and procedures, metrics dashboards, contracts, business service agreements, and prior audit results. Prepare reports synthesizing results and highlighting implications of findings. Deliver report findings to applicable department leadership.Collaborate with internal and external business partners to develop corrective action plans to address the root cause of audit findings and gaps and monitor corrective actions plans for resolutionUtilize data analytics to monitor and trend specific compliance requirements for key areas. Work with various business units and systems to identify and develop effective data mining practices as a means to more proactively monitor operational compliance with key regulatory requirements. Train compliance and operational staff, as appropriate, on use of developed data analytics. Assist with ongoing risk assessment and identification of new or emerging risks. Review business processes to determine compliance with state and federal regulatory guidance. Establish positive working relationships with management to provide input on risks and controls and ensure a sustained understanding of compliance requirements while maintaining independence and objectivity.Create and maintain tools for delivering compliance analytical data and status reports to internal and external clients.Utilize project management techniques to assess compliance program risks, monitor and facilitate task completion, apply appropriate escalation to remove barriers, and ensure projects achieve desired compliance program objectives.Provide support or project management for any other related audit and compliance initiatives and assist in carrying out other related responsibilities as required by the Corporate Compliance team. Offer input on strategies to ensure compliance with key regulatory deliverables. Coach/mentor other Compliance Specialist staff regarding audit methodology and report writing. Present compliance-related topics to other departments (e.g., policy and procedure requirements, self-reporting, conflict of interest) and train staff on compliance-related matters as needed.Identify areas for operational improvement in the Compliance department and, as directed by supervisor, lead efforts to implement improvements and standardization within the department. Lead audits, reviews, investigation of incidents, and monitoring activities. Monitor for trends and educational/training needs. Research and assist in interpreting CMS, State and commercial regulatory requirements. Keep current on all applicable regulatory requirements and industry news. Serve as subject matter expert on the incidents module in Compliance 360 and work to correct any issues. Assist Compliance 360 administrator with other issues and training needs. Collaborate with the Compliance Assistant Director in preparing for the quarterly Compliance Oversight Subcommittee meetings, attending the meetings as requested to facilitate compliance-related discussions regarding various operational areas. Other projects or duties as assigned. EducationBachelors' degree; demonstrated experience may be considered in lieu of degree.Required ExperienceFive years experience with internal or external audits, internal controls or regulatory compliance. Three years in health care or the health insurance industry.Preferred ExperienceExperience in the health care and/or insurance industry in auditing and/or compliance role. Experience in developing and utilizing data analytics to monitor compliance. Implementation, administration and oversight of processes to ensure compliance with Medicare Advantage, Medicaid managed care, and State Exchange lines of business.THE UCARE DIFFERENCEUCare is proud to be a recognized Star Tribune Top Workplace for the 7th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply. As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.