Compliance Specialist 2 at Genex Service LLC in Wayne, Pennsylvania

Job Description:

Genex Service LLC


Compliance Specialist 2

US--Remote

Job ID: 24-17363
Type: Regular Full-Time
# of Openings: 1
Category: Product & Program Management
Mitchell International, Inc.

Overview

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Responsibilities

This is a full-time remote position that can be located anywhere in the U.S.

The Compliance Specialist performs the coordination and preparation of internal and external audits in accordance with regulatory standards. Collaborates with internal and external clients to develop positive and proactive approaches to regulatory compliance. Abstracts information for reporting and translates information into requirements. May interact with regulatory agencies on defined matters. Recommends strategies for quality assurance and assists with the corrective action as it relates to policy and procedure changes and workflow changes to maintain regulatory compliance.

The Compliance Specialist actively monitors regulatory changes and industry developments relating to Utilization Management compliance and quality. Interdepartmental coordination to monitor and update quality improvement and utilization management initiatives. The Compliance Specialist may assist with preparing submissions for the initial and renewal of Utilization Review (UR) state licenses. The Compliance Specialist may interact with our legal department and other corporate regulatory resources to conduct research for licensing and compliance. This role will require collaboration with internal/external stakeholders to communicate current and relevant information and requirements.

This role will support the Senior Manager, Regulatory Affairs in developing, implementing, monitoring and updating quality improvement and utilization management initiatives as well as policies and procedures. Provides support for the ongoing compliance with URAC accreditation standards and preparation of URAC audits.

Responsibilities may include the following and other duties may be assigned.

• 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.

Qualifications

• 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.
  
• Bonus: Clinical background such as case managers, registered nurse, initial clinical reviewer or clinical peer reviewer.
• Requires practical knowledge and demonstrated competence within job area typically obtained through advanced education combined with experience.
• Experience with policy review, report development/gathering to support URAC accreditations.
• Experience with Utilization Management clinical reviews.
• Experience in organization, tracking, and trending of information.
• Experience with Utilization Management Licenses (Nationwide).
• Experience with internal auditing.

Benefits

We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $52,719.00 - $82,000.00 annually, and will be based on a number of additional factors including skills, experience, and education. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-Remote #LI-FP1



Salary: $52719.00 - $82000.00 annually

PI255407893

Salary:

$52,719.00

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