Description

UPMC Health Plan is seeking a Compliance Specialist for their Medicare Compliance Team!

The Compliance Specialist is responsible for the monitoring and reviewing of standards and reporting requirements that are an essential component of this position. This individual must have the ability to perform the oversight planning for and implementation of managing all tasks required to meet business needs within the targeted deadlines. Will work with various Health Plan staff to manage the day-to-day activities necessary to meet the myriad requirements of the contract with the CMS (Centers for Medicare & Medicaid Services) while exceeding their service expectations.

Preferences: Medicare Advantage experience and knowledge of the Medicare Communication Marketing Guidelines are preferred. Microsoft Office experience preferred. 

This position is a combination of in-office and work-from-home. 

Responsibilities:

• Develop and/or design reports for senior administration as requested by management staff.
• Establish continuous readiness preparedness for compliance processes.
• Work collaboratively with management to achieve staff integrated efficiencies. Implement process and/or product improvements on a day-to-day basis, as assigned.
• Perform analysis of client business problems, participates in identifying solutions, and ensures that the appropriate resolution occurs.
• Reports on a weekly basis status of all assignments, pertinent information obtained during report week and provides projections for upcoming week to the Senior Director and Manager.
• Work closely with Legal Department to promote legal compliance of program reporting.
• Review policies against contractual requirements and participate in the policy committee when applicable.
• Coordinate with Internal Audit, and Quality Review t to coordinate, monitor, track and trend audits.
• Research laws, regulations, contractual requirements industry custom, best practices and company preference.
• Coordinate with the Network Vendor liaison to monitor vendor performance standards.
• Identifies timelines for reporting requirements and notifies appropriate staff.
• Assists with the oversight of compliance programs to satisfy contractual requirements and not to place UPMC for You, UPMC for Best Health or UPMC Health Plan in violation of any federal, state regulations, or accreditation standards.
• Assist in developing regulatory documentation requirements, establishes monitoring tasks and resolves issues.
• Implement tactical directives emanating from the strategic business plan.
• Serve as the primary point of contact for programs by serving as the communication liaison with UPMC Health Plan Communication Department, various Health Plan departments and the Department of Human Services. Monitor all member and provider communications and documents.
• Review DHS and other various web-sites and communicate new and often complex Government rules and regulations relating to compliance requirements.

Qualifications

• Bachelor's Degree required.
• Two years of demonstrated experience/knowledge of regulatory compliance or program management preferred.
• Medicare Advantage experience and knowledge of the Medicare Communication Marketing Guidelines
• Microsoft Office experience  
• Excellent organizational capabilities

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

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Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.