The role of the Network Compliance Coordinator is to support the Network Management team by providing oversight of regulatory requirements and coordinating the completion of regulatory reporting within regulatory specifications and timelines.
- Identifies and prioritizes key risk areas.
- Document and monitor legal and regulatory requirements related to subject matter pertaining to the Network Management team.
- Develops and implements a tracking system and timelines for legal and regulatory submissions related to the Network Management team.
- Utilizes industry groups and research technology sources for retrieving legal and regulatory provider requirements.
- Delivers accurate, detailed and timely analysis of new laws and regulations impacting the health plan operations to build and maintain compliance and avoid the potential for risk exposure.
- Consults with Compliance/Quality teams to support continuous operational improvements into daily business practice.
- Monitors and reports to the Manager the progress with the objectives given to the Network Management team.
- Coordinates and manage regulatory audits and submissions on behalf of Network Mangement team.
- Provides ongoing technical guidance on potential regulatory impacts to ensure compliance processes are maintained.
- Has the ability to learn reporting tools and assists in maintaining compliance reporting.
- Participates in health plan compliance reviews.
- Bachelor's degree.
- Strong written and oral communication skills.
- Proven ability to maintain confidential communications.
- Strong organizational and technical skills.
Minimum of 3 years in healthcare compliance with health plan compliance preferred. Preferred experience in Medicare Advantage and Health Exchange product lines.
B. Licenses, Registrations, or Certifications