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, this position will document projects, prepare reports and identify trends and key focus areas using data analysis. Specific duties and responsibilities include: Provide input and assistance with the annual risk assessment used to develop the annual audit and monitoring calendar. Communicate emerging risk areas for ongoing risk assessment.Conduct internal and delegated entity compliance audits. Assist in the project development by performing necessary research and preparation, development of the scope, objectives, criteria and testing methodology of the audit project.Demonstrate a solid understanding of project management and be able to communicate the audit project plan to relevant internal and external parties. Perform the fieldwork adequately and accurately; appropriately documenting all steps and results. Prepare reports synthesizing results and highlighting implications of findings. Deliver report findings to applicable department leadership with professional demeanor.Lead audits, reviews, investigation of incidents, and monitoring activities. Monitor for trends and educational/training needs. Mentor other staff in the processes and documentation involved.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 resolution.Utilize 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.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.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, lead efforts to implement improvements and standardization within the department.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 Associate Director in preparing for the Compliance Oversight Committee meetings, attending the meetings as requested to facilitate compliance-related discussions regarding various operational areas. Other projects and 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 8th 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.