Homeoffice Compliance Specialist bei Healthy Alliance

Description

Life at Healthy Alliance

At Healthy Alliance, our purpose is to improve health and empower communities facing barriers. Every community has its own needs, affecting the health of those who live, learn, work, and play within them. Our network brings together organizations, big and small, to coordinate and collaborate so that all communities have reliable access to the resources they need. Why? Because every New Yorker deserves the same opportunity to be healthy.

Designated as the Social Care Network (SCN) Lead Entity for the Capital Region, Central NY, and North Country under New York’s 1115 Waiver Amendment’s SCN & Health-Related Social Needs (HRSN) Program, we are responsible for ensuring that there is a seamless, consistent end-to-end process for screening, navigation, and the delivery of services – including food, housing, and transportation to thousands of Medicaid Members. Transformative in nature, this novel Program will further sustain our vision of cultivating a world wherein everyone has a fair and just opportunity to be as healthy as possible.

As a 2019-2024 Albany Business Review’s Best Places to Work and a 2021-2025 Modern Healthcare’s Best Places to Work in Health Care award recipient, we strive to maintain a culture wherein high-performing, mission-driven team members collectively work toward better health for all. Dedicated to promoting a culture built upon autonomy, mastery, and purpose, we believe our differences in strengths and perspectives play an integral role in propelling us forward, while our core values ground us, serving as the common thread that unites our team.

Why You Should Join Healthy Alliance

We offer amenities, professional development opportunities, events, and programming that support the interests of our teams while expanding and enriching our culture. Some of the benefits you can expect when you join Healthy Alliance include: 

• Competitive compensation package  
• Comprehensive insurance benefits available the 1st of the month after hire, including but not limited to medical, dental and vision, group short-term disability and life insurance with buy-up options, flexible spending and HSA company-contributed accounts, and more 
• 401K with a company match 
• Unlimited paid time off after 90 days of employment 
• Company-sponsored training and certification opportunities 
• Remote employer with flexible work schedules 
• A workplace that values safety, respect, employee engagement, recognition, and diversity 
• Salary range: $83,050-$95,508 per year, commensurate with experience 

Who You Are

The Compliance Specialist works alongside the Healthy Alliance Compliance Officer to assist with the development, implementation, monitoring, and evaluation of the Compliance Program for effectiveness.

What You’ll Do 

• Conduct Healthy Alliance internal audits established to monitor effectiveness of compliance standards and the Compliance Program.
• Assist the Compliance Officer and Compliance Committee in establishing auditing methods to improve Healthy Alliance’s quality of service and to reduce vulnerability to fraud, abuse, and waste.
• Investigate and act on complaints and matters related to compliance, including the flexibility to design and coordinate internal investigations (e.g., responding to reports of problems or suspected violations) and any resulting corrective action with all departments, providers, sub-providers, agents, and, if appropriate, independent contractors.
• Manage Healthy Alliance’s complaint and feedback tracking mechanisms and report findings, trends, and corrective actions on a regular cadence.
• Maintaining a reporting system, including an anonymous means to report, and responding to concerns, complaints, and questions related to the Compliance Program.
• Evaluate the effectiveness of the Compliance Program, policies and procedures, and Code of Conduct.
• Implement and maintain organizational policy and document control systems, ensuring version control and compliance with industry standards through regular audits and reviews.
• Collaborate cross-functionally to gather information, ensure documents meet business requirements, and review for errors and inconsistencies.
• Manage the archiving and retention of documents, continuously seeking improvements in policy creation and documentation processes.
• Monitor the adoption, implementation, and maintenance of the Compliance Program.
• Develop and implement Compliance Program policies and procedures (P&P) and Code of Conduct.
• Review and revise, periodically, the Code of Conduct, the Compliance Program, and policies and procedures as changes occur within Healthy Alliance, and/or in the law, regulations, or governmental and third-party payers.
• Develop, implement, and monitor the annual Compliance Work Plan.
• Develop, coordinate, and participate in a multifaceted educational and training program that focuses on the elements of the Compliance Program and seeks to ensure that all affected individuals consistent with roles and any associated risk areas are knowledgeable of, and comply with, pertinent federal and state standards and Healthy Alliance’s Code of Conduct.
• Ensure that excluded individuals and entities are not employed or retained by the organization.
• Ensure all contracted organizations are credentialed in accordance with required standards and tracked in Healthy Alliance’s designated software.
• Lead efforts to communicate awareness of the existence and contents of the Compliance Program.
• Ensure that independent contractors and contractors (recipient service provision, vendors, billing services, etc.) are aware of the requirements of Healthy Alliance’s Compliance Program.
• Continue the momentum of the Compliance Program and the accomplishment of its objectives.
• Perform other responsibilities and duties as assigned.

This job description is not designed to cover or contain a comprehensive listing of task activities and/or duties that are required of the employee for this job. Responsibilities and activities may change at any time with or without notice.  

Requirements

What You’ll Need 

Education 

• Minimum of an associate’s degree in a related field, bachelor’s preferred.

Professional Work Experience 

• Minium of five (5) years of experience in auditing, credentialing, or a related field.

Knowledge, Skills, and Abilities 

• Intimate knowledge of New York State Medicaid policies.
• Intimate knowledge of social services.
• Proficient use of all Microsoft Office products.
• Excellent communication and writing skills and demonstrated ability to effectively communicate at all levels within and outside the organization.
• Organized and innovative analytical person with the ability to perceive, understand, and interpret facts quickly and precisely.
• Perform all work in accordance with Healthy Alliance core competencies and values.

Your next career opportunity is at Healthy Alliance!

This position involves sedentary work that primarily involves sitting/standing, use of typical office equipment such as a computer, laptop, and cell phone. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Equal Opportunity Employer

Healthy Alliance is an Equal Opportunity Employer and does not discriminate against any employee or applicant on the basis of age, ancestry, color, family or medical care leave, gender identity or expression, genetic information, marital status, medical condition, national origin, physical or mental disability, political affiliation, protected veteran status, race, religion, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable laws, regulations and ordinances. We adhere to these principles in all aspects of employment, including recruitment, hiring, training, compensation, promotion, benefits, social and recreational programs, and discipline. If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected].

Privacy Requirement

This job function involves potential access / interaction with protected health information. Position will be required to abide by company policies and procedures that support federal, state, and local HIPAA regulations. Any violations will be subject to company policy which includes disciplinary actions up to and including separation of employment.  

Healthy Alliance is an At-Will Employer.