Compliance Consultant - Medicare Advantage
Job Type
Full-time
Description

Come Smile with Us!


Are you a compliance professional seeking a new opportunity with a supportive and collaborative team? Delta Dental of Iowa invites applications for Compliance Consultant to provide reasonable assurance of compliance with applicable federal and state laws and governance standards, policies and procedures, and Delta Dental of Iowa (“DDIA”) compliance related policies and procedures. This is accomplished by providing effective and efficient oversight of the related operational functions. You will use your strong detail orientation and effective problem solving skills to assist in identifying, assessing and mitigating compliance and operational risks, opportunities and potential gaps. You will also provide Medicare compliance related training to employees and serve as a key resource and business partner to implement required policies, procedures, and practices.


Why Delta Dental? We provide dental and vision insurance to more than 1.5 million Iowans. As a not-for-profit insurance company, our mission is to improve the health and smiles of the people we serve. We give back to Iowa communities by investing in health and wellness initiatives that make a measurable difference in the overall health of Iowans. Come see why we are passionate about "Bringing Smiles" to our customers. Our team enjoys competitive pay and benefits, an awesome "One Team" approach, and a company culture that fosters "Exceptional Quality Service" and "Leadership at All Levels." Love where you work!  


Essential Functions and Principal Accountabilities:

  • Assist manager with general oversight and implementation of Medicare Advantage compliance and program integrity processes. 
  • Serve as a key resource to business areas regarding regulations and act as a liaison, between the business units and outside partners and regulators regarding compliance and regulatory questions, issues, or interpretations. 
  • Research and respond to compliance-related questions providing guidance in an effective, efficient, professional, and timely manner. 
  • Lead ongoing development and/or facilitation of compliance-related training for employees, temporary staff, and independent contractors. 
  • Review marketing collateral, insurance forms and documents for regulatory compliance.
  • Interpret, analyze, and determine the impacts of new or changed regulations or guidance or contractual requirements to policies, procedures, and processes. Summarize and report potential impacts to business areas in a timely manner.
  • Support Compliance department with third-party audits and exams by responding to inquiries and/or fulfilling requests, as needed. 
  • Create, review, and revise Medicare compliance and program integrity management related policies and procedures according to schedule (i.e., Compliance Plan, Program Integrity Plan).  
  • Provide oversight for compliance-related functions including but not limited to grievances, appeals, and incident reporting and response procedures. 
  • Partner with functional areas to determine the root cause of issues and help develop corrective action plans to address the same. Follow-up on all open issues to ensure the action plans are implemented in the most timely and effective manner. Document and report the status on a regular basis.
  • Create reporting formats and report audit/review findings in a timely and accurate manner. 
  • Foster mutually beneficial relationships with all functional areas and levels of management by continuously acting as a partner and resource to them. 
  • Perform other duties as assigned.
Requirements


  1. Bachelor’s degree in Business or related field, or equivalent work experience
  2. Five or more years’ experience as a compliance consultant or supervisor, paralegal, internal auditor or federal or state examiner. 
  3. Five or more years’ experience analyzing and interpreting federal and state regulations and guidance and transferring it into processes, policies, procedures, and training materials to comply.
  4. Five years’ experience in the Medicare insurance industry, preferred. 
  5. In-depth understanding or working knowledge of the laws and regulations applicable to the dental/health insurance industry such as HIPAA, and/or Medicaid and Medicare Advantage related regulations, is preferred.
  6. Self-directed individual with ability to work independently and as part of a team to achieve goals and objectives.
  7. Detail and results oriented individual with demonstrated abilities to prioritize, delegate, organize, and function effectively with multiple concurrent assignments/projects.
  8. Strong problem-solving skills
  9. Strong, clear and concise writing and presentation skills.
  10. Excellent interpersonal, analytical, change management, and communication skills.
  11. Proficient using Microsoft Office applications specifically Word, Excel, Visio, and Power-Point.

Delta Dental of Iowa is an Affirmative Action and Equal Opportunity Employer committed to providing equal employment opportunity for all persons without unlawful regard of race, color, religion, sex, sexual orientation, gender identity, age, national origin, individuals with disabilities, protected veteran status, or any other legally protected basis.


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