Claims Government Programs Compliance Coordinator Job Bloomington area,Minnesota USA,Management

Health Partners is hiring a Compliance Riverview Service Center Coordinator. This position is responsible for ensuring that the department meets its regulatory requirements; including the day-to-day aspects of the Membership Accounting or the Claims monitoring and auditing. The goal of this position is to ensure efficient operational compliance with program policy and standards. This person must be proactive and anticipate potential operational or policy problems, report to leadership team, and take steps to prevent or reduce potential adverse results for the program or its participants.

The position will be responsible for coordinating internal reviews, external reviews and audits of products administered by Riverview Membership Accounting or Riverview Claims department. The Coordinator also will be assigned ongoing responsibility and accountability for certain department functions and will assist the department leaders as assigned.

ACCOUNTABILITIES

Reviews contract and regulatory requirements and disseminates information to appropriate team members. Leads implementation as necessary within required time frames.

Maintains a tracking system for monitoring contract & regulatory requirements that impact Riverview Membership Accounting or Riverview Claims.

Resource for regulatory interpretation questions for Riverview Membership Accounting or Riverview Claims.

Proactively identifies issues and works with partnering departments to develop appropriate corrective action plans for identified issues. Maintains files and documentation of monitoring activities and any resulting corrective action.

Consults Government Programs, Product Management, Law and the Internal Audit Department regarding questions related to compliance.

Coordinate external reviews and audits of Riverview Membership Accounting or Riverview Claims products including:

Prepares and organizes documentation for audits, including work plans, manuals, site visit preparations, and universes.

Manages documentation as required for post-audit follow up activities.

Develops and maintains positive working relationships with internal partners.

Participates with decision making and policy setting for Monitoring and Compliance activities and initiatives.

Represents Riverview Membership Accounting or Riverview Claims on internal and external committees as designated.

Coordinates the updating and ongoing testing of the Department business continuity and disaster recovery planning and preparation.

Responsible for implementation and oversight of the records retention process for Riverview Membership Accounting or Riverview Claims.

Responsible for Part D Reporting for Riverview Membership Accounting or Riverview Claims.

Other duties and responsibilities as needed.

REQUIRED QUALIFICATIONS

Bachelor's Degree or equivalent experience
Three to five years' experience working in a healthcare or business environment
Excellent organizational, problem-solving and communication skills with demonstrated ability to present and explain complex information clearly
Effective project management experience
Strong independent judgment, initiative, analytical skills, and personal integrity
Knowledge of Health Partners operations
Ability to be proactive and take initiatives and oversee projects

PREFERRED QUALIFICATIONS

Direct work experience with regulatory matters.

DECISION-MAKING

Refers issues identified in the course of monitoring to the appropriate leader.
Review of appropriate regulatory, contractual and operational considerations before giving direction on program compliance.
Confers with Riverview Membership Accounting or Riverview Claims management on material/significant policy or regulatory changes.

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