Marketing Compliance Specialist

Who we are
Community Health Plan of Washington is
an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to:

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Become an anti-racist organization.
• Create an equitable work environment.

About the Role
The Marketing Compliance Specialist is responsible for developing, implementing and overseeing programs, policies, and practices to ensure CHPW's marketing and sales efforts comply with applicable laws, regulations and contract requirements. This role ensures compliance and adherence to regulatory requirements by monitoring state and federal regulations, internal policies and procedures to advise Sales and Marketing management on needed actions to remain compliant. In addition, this role will review and be familiar with published quality standards (e.g. NCQA standards) that impact marketing materials. This role plays a critical function for regulatory Marketing Compliance.
To be successful in this role, you:

• Are committed to serving the underserved community and treating others with respect, courtesy, and maintaining member confidentiality.
• Have minimum of three years health care Marketing Compliance experience
• Have experience working with regulatory agencies with oversight over health plans, including state departments of insurance and/or CMS preferred.
• Are familiar with Federal and State regulatory requirements for marketing and sales of Medicaid, Exchange and Medicare Advantage health plans.

Essential functions and Roles and Responsibilities:

• Oversee the day-to-day sales and marketing policies and procedures to ensure compliance with contractual and regulatory federal and state requirements and keep abreast of changes to Federal and State marketing requirements and guidance, enforcement trends and best practices in compliance programs.
• Provide education and guidance to Marketing/Sales leadership and staff to ensure compliance with contractual and regulatory requirements.
• Develop and manage a strong system of Marketing/Sales internal processes to ensure compliance as needed.
• Facilitate timely submissions of marketing material and web content to CMS and HCA
• Review current policies, procedures, and practices to identify compliance gaps and areas for improvement and update policies and procedures to address organizational and regulatory changes, as appropriate.
• Ensures sales and marketing project/initiative outcomes meet all quality standards as required by the State of Washington and/or by NCQA Accreditation Standards.
• Establish a specifically designed compliance program that effectively ensures alignment from a marketing/sales compliance perspective.
• Educate and communicate verbally and in writing to Marketing/Sales leadership and impacted staff any new or changes to contracts and regulations, assisting with the interpretation of the intention of the guidelines.
• As part of implementing Marketing Compliance program, define process to monitor and ensure marketing materials meet contractual and regulatory requirements, including spot checking materials as needed.
• Build relationships with responsible market contacts and external regulators and coordinate compliance related communication/interaction with regulators, as necessary, establish and manage relationships with vendors to ensure alignment from a Marketing Compliance perspective.
• Educate departments outside of Sales and Marketing on the material review submission process and forms. Collaborate with the CHPW Compliance team to ensure other departments understand and adhere to compliance requirements for their communication materials.
• Responsible for submissions to CMS (Centers of Medicare / Medicaid Services) and/or the Health Care Authority, for marketing/sales materials and website, and for non-marketing communication material from other departments
• Act as the main liaison between Sales/Marketing and legal/compliance departments, handling internal and external compliance inquiries, resolving issues collaboratively, and overseeing corrective action plans. Maintain comprehensive compliance records, including audits and training documentation.
• Provide input and representation on key compliance initiatives, meetings, and committees and act as a key participant in both on and offsite external audits, including federal and state contract audits, working with the regulators, as necessary.

Knowledge, Skills, and Abilities:

• Advanced knowledge and ability to effectively use Microsoft Excel, MS Word, and Outlook.
• Knowledge of relevant National Committee of Quality Assurance (NCQA) standards in relation to sales and marketing
• Knowledgeable in process improvement
• Excellent verbal and written communication skills
• Teamwork and collaboration skills
• Organization skills
• Analytical and critical thinking skills and problem-solving techniques.

As part of our hiring process, the following criteria must be met:

• Complete and successfully pass a criminal background check

Criminal History:includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.

• Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency
• Vaccination requirement (CHPW offers a process for medical or religious exemptions)
• Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.

Compensation and Benefits:
The position is FLSA Exempt and is not eligible for overtime. Based on market data, this position grade is 65 (see full range below) and has a 10% annual incentive target based on company, department, and individual performance goals.
CHPW offers the following benefits for Full and Part-time employees and their dependents:

• Medical, Prescription, Dental, and Vision
• Telehealth app
• Flexible Spending Accounts, Health Savings Accounts
• Basic Life AD&D, Short and Long-Term Disability
• Voluntary Life, Critical Care, and Long-Term Care Insurance
• 401(k) Retirement and generous employer match
• Employee Assistance Program and Mental Fitness app
• Financial Coaching, Identity Theft Protection
• Time off including PTO accrual starting at 17 days per year.
• 40 hours Community Service volunteer time
• 10 standard holidays, 2 floating holidays
• Compassion time off, jury duty

Sensory/Physical/Mental Requirements:
Sensory*:

• Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.

Physical*:

• Extended periods of sitting, computer use, talking and possibly standing
• Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
• Frequent torso/back static position; occasional stooping, bending, and twisting.
• Some kneeling, pushing, pulling, lifting, and carrying (not over 25 pounds), twisting, and reaching.

Mental:

• Ability to learn and prioritize multiple tasks at a given time and have the capability of handling demanding situations. Analytical/problem solving/critical thinking ability.

Work Environment:
Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)