Compliance Coordinator - Compliance - Paramount - Full Time - Days
ProMedica’s health plan, Paramount Insurance, offers health insurance products across six Midwest states. Paramount is an Ohio-based health insurance company, headquartered in Toledo. The organization has more than 800 employees dedicated to serving their health plan members.
Paramount offers Medicare Advantage and Marketplace Exchange health plans for individuals and families. Paramount maintains accreditation by the National Committee for Quality Assurance (NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products for employers of any size, including medical, dental, vision and workers’ compensation, as well as vocational rehabilitation, life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount strives to provide an exceptional experience to every member. For more information about Paramount, please visit our website. http://www.paramounthealthcare.com.
The Compliance Coordinator will be responsible for assuring assigned business units have efficiently operationalized regulatory requirements and will assist assigned business units in implementing changes to processes to assure continued compliance with federal and state regulations.
1. Active participation on Paramount Compliance Council.
2. Function as the day-to-day resource for compliance questions and concerns for assigned areas of responsibility, including but not limited to oversight of departmental policies and procedures.
3. Attend department leadership meetings (no less than quarterly). Maintain a standing agenda for these meetings based on agenda item standardization as developed by the Paramount compliance council. For example: Compliance and privacy monitoring metrics, significant trends identified and plans for remediation, address compliance issues and concerns raised by leadership and communicate these back to the Paramount compliance council to ensure issue is addressed at other BUs as well, and industry trends, law/regulation changes and best practice.
4. Monthly analysis of Compliance Monitoring data and other metrics for issues and trends. Evaluate compliance with governmental and other regulations. Work with individual department heads when data indicates inadequate compliance to assist in action plan development and resolution.
5. Initiate and direct the conduct of internal and external investigations in response to reports of possible compliance violations, state and federal regulator queries, and/or complaints filed by enrollees/providers with state and/or federal regulators.
6. Facilitate, as appropriate, corrective actions as a result of internal investigation with all departments, providers, and employees.
7. Assist in establishing methods to improve the efficiency and quality of services and in reducing vulnerability to fraud, abuse, and waste.
8. Assist in the assessment of department specific learning needs and knowledge gaps using both internal resources (i.e. audit and/or investigation results, data analysis, reported deficiencies) and industry identified high risk areas. Assist in the development of department specific compliance training/education. Provide educational material to the Management team regarding new laws and regulations and issues affecting their specific areas of practice.
9. Maintain ongoing expertise in the field of health plan compliance including review of any issuance by governmental agencies such as the ODI, ODM, and/or CMS, including fraud alerts, special advisories or proposed rules.
10. Prepare reports, charts and other documentation as necessary to communicate compliance issues/concerns to appropriate parties. Follow compliance project work plans, timelines and milestones.
- Education: Bachelor’s Degree in Business Administration, Law or related health care field.
- Years of Experience: Three (3) years audit, legal or compliance experience in a health care setting or managed care organization. Familiarity with health care operations and health care regulatory environment.
- Education: Master’s Degree in Business Administration, Law or related healthcare field.
- Skills: LEAN and/or Six Sigma training.
- The CO must be highly ethical, and able to maintain strict confidentiality.
- The CO is expected to uphold and communicate the principles of the Compliance plan at all times.
- The ability to collect, analyze and summarize data from a variety of sources is essential to this position.
- Must have superior verbal and written communication skills, including the ability to clearly communicate complex regulatory guidelines and coordinate communication among groups.
- Must be able to establish a structure of communication and teamwork with the BU/Department leadership.
- Must be able to understand directions and respond to inquiries; must have excellent interpersonal skills and ability to work with people at all levels of the organization.
- Must be able to move about business offices and between work stations.
- Must be fully proficient with Microsoft Office products including Word, Excel and Power Point.
- Must be able to occasionally move lightweight materials.
- Weight requirements according to the Department of Labor’s Dictionary of Occupational Titles.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact firstname.lastname@example.org
Equal Opportunity Employer/Drug-Free Workplace
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