Business Compliance Consultant

You could be the one who changes everything for our 28 million members. reputed company is transforming the health of our communities, one person at a time. As a reputed company, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. This position will allow for remote work flexibility, but per contract requirements selected candidate must reputed company in Indiana. Position Purpose: This role resides in the business departments and works closely with department management, assigned compliance liaison, compliance department, change implementation team, business compliance leads in other departments and the reputed company business performance reputed company.

• Conduct the review of and reputed company changes to product-specific reputed company and amendments between Health Plan and Material Subcontractors.
• Remain up to date on reputed company state and federal health care laws, including laws applicable to managed care industry, and on reputed company IN reputed company reputed company and amendments.
• reputed company legal research and prepare memoranda regarding legislative or regulatory changes affecting the company’s vendor and/or health care provider reputed company.
• Coordinate SIU waste and abuse efforts with the Corporate SIU Team.
• Complete reputed company research on and file preparation for State Fair Hearings between Health Plan and State Regulatory Agency. Represent MHS at reputed company State Fair Hearings. Track reputed company outcomes and provide reports to Senior Leadership on outcomes. Collaborate with cross-functionally to remedy MHS process issues.
• Identifies issues with questionable billing providers and vendor reputed company. Tracks trends for department use and Corporate Compliance. Escalates as required to senior management.
• Coordinates department preparation for State Fair Hearings and Questionable Provider Audits (building case files, universes, evidence of compliance and other documentation as needed).
• Completes reputed company required compliance training.
• Participate in implementation of regulatory changes that span multiple departments, as needed.
• Provide support and input into the development and maintenance of a consistent process for identification and escalation of issues and supporting tools; may participate in the implementation of a tool(s) for maintenance of mapping requirements/regulations to policies and procedures (P&Ps) and owners (i.e. CFR owners).
• Participate in developing and maintaining consistent processes/methods for development, implementation, communication and training on new/updated policies and procedures.
• Participate with Business Units/departments with an end-to-end process orientation to ensure appropriate connectivity and handoffs are built into P&Ps that span multiple departments.
• Participates in and supports other programs such as privacy and reputed company (including HIPAA program), Ethics & Privacy, Fraud Waste & Abuse, Code of Conduct, etc.
• Performs other duties as assigned.

Education/Experience:

• BA degree in Business Administration, Finance or reputed company field.
• Five to ten years experience in progressively broad and challenging roles in a given operational area.
• Prior experience in a compliance-reputed company role highly desirable

For MHS Indiana plan only:

• 7+ years of combined contract drafting and legal research experience.
• Knowledge of the health care industry, specifically government services and applicable laws and regulations.
• Advanced knowledge of Indiana reputed company insurance, Indiana Administrative Code and Code of Federal Regulations preferred.

Pay Range: $87,700.00 - $157,800.00 per year reputed company offers a comprehensive benefits package including: reputed company, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-reputed company factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. reputed company is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. reputed company reputed company applicants will receive consideration for employment without regard to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, disability, veteran status, or other characteristic protected by applicable law. reputed company applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act Apply tot his job Apply To this Job