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SalaryJob Responsibilities:
The Regulatory Compliance Consultant is responsible for developing, executing and maintaining an effective compliance program to prevent and detect violations of law and other misconduct. Promotes ethical practices and a commitment to compliance with applicable rules, regulations and internal policies and procedures. Provides regulatory guidance to our operational areas and communicates effectively with leadership at various levels, sharing opportunities for operational improvements. Partner with sales to provide regulatory guidance and ensure agents and brokers adhere to all State and Federal regulatory requirements and Sentara health plan guidelines.
Documents regulatory requirements. Assists as necessary with the distribution and tracking of regulatory guidance from the Centers for Medicare & Medicaid Services (CMS) via HPMS memos to ensure timeliness and applicable deadlines are met. Respond to Complaints Tracking Module (CTM) requests. Responsible for maintaining Regulatory Compliance Medicare policies and procedures. Maintains annual regulatory calendar.
Requirements:
Bachelor's degree and 5 years combined compliance/healthcare experience required or 10 years' experience in lieu of degree. Required to manage multiple projects simultaneously, must be self-motivated, organized and possess excellent verbal and written communication skills. Candidate should possess strong interpersonal skills. Requires proficient experience with computer software such as Work, Excel, PowerPoint, Visio, etc. Healthcare Compliance Cert. (CHC) or Certified Internal Auditor or master's level in a health-related field preferred. Previous experience in accounting (analytical) preferred.
Sentara Overview
For more than a decade, Modern Healthcare magazine has ranked Sentara Healthcare as one of the nation's top integrated healthcare systems. That's because we are dedicated to growth, innovation and patient safety at more than 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals.
Our Benefits:
Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
For applicants within Washington State, the following hiring range will be applied: $67,791.36 - $101,687.04.
Candidates must have a current residence in one of the follow states or being willing to relocate: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington State, West Virginia, Wisconsin, Wyoming
- Certified Internal Auditor (CIA) - Certification - Other/National
- Officer of Healthcare Compliance, Certified (OHCC) - Certification - American Institute of Healthcare Compliance (AIHC)
Primary Job Duties may include, but are not limited to:
- Familiar with the Centers for Medicare & Medicaid Services (CMS) regulatory chapter manuals.
- Familiar with State regulatory requirements relating to health plans.
- Required to manage multiple projects simultaneously, must be self-motivated, organized and possess excellent verbal and written communication skills.
- Research regulations, documents, report and disseminate the CMS requirements.
- Implement problem-solving processes.
- Ability to work autonomously.
- Candidate should possess strong interpersonal skills.
- Assist in development and/or delivery of compliance training and education.
- Evaluate, develop, implement and maintain regulatory compliance policies and procedures.
- Responsible for overseeing compliance readiness assessments and performing gap analysis.
- Acts as a consultative resource and must be knowledgeable of regulatory requirements.
- Review, approve and submit Medicare collateral material.
- Review, analyze, document and respond to Medicare complaints received from CMS.
- Attend the CMS education and health plan training.
- Perform other regulatory and compliance duties as assigned.
- Bachelor's Level Degree
- Healthcare 7 years
- Compliance 7 years
- Project Management 2 years
- Internal/External Audit 3 years
- Reading Comprehension
- Microsoft Office
- Complex Problem Solving
- Writing
- Time Management
- Technology/Computer
- Speaking
- Judgment and Decision Making
- Active Listening
- Social Perceptiveness
- Mathematics
- Critical Thinking
- Active Learning
