Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Lead Compliance Specialist, Medicaid - Remote
- 💼
- EmblemHealth
- 📅
- 5 days ago Post Date
Summary of Job
Partner with functional departments/vendors/delegates to ensure they are in full compliance with all actionable and informational regulatory notices. Identify new and revised regulatory guidance; create paths of communication to business units. Ensure that business areas have implemented regulatory requirements, by collecting artifacts that demonstrate that process, operations, trainings, policies, and procedures have been updated. Provide subject matter expertise and guidance for assigned business areas as it relates to day-to-day needs, including but not limited to, implementations and corrective action plans. Manage projects as needed.
Responsibilities
- Conduct regulatory research to address compliance inquiries.
- Provide regulatory guidance and support for business process improvement efforts.
- Communicate with business leadership regarding events, training, and processes related to regulatory compliance initiatives and/or memos.
- Conduct monitoring and auditing of assigned business areas.
- Ensure that business areas/ delegates understand and address all actionable memos or directives and upload proof of implementation to centralized Compliance Department repository.
- Update and maintain centralized Compliance Department repository records as necessary and appropriate.
- Support external audits or regulatory requests as needed.
- Provide business areas with regulatory guidance to address and mitigate performance or monitoring gaps while ensuring regulatory requirements are met.
- Support business areas in creating and updating P&Ps, trainings, reports, monitoring activities and any project related function to ensuring compliance with regulatory memos and audits by internal stakeholders, vendors, and delegates.
- Contribute to Compliance Department committee and subcommittee materials as needed.
Qualifications
- Bachelor’s degree (Required)
- Advanced degree (MPH, MHA, JD and/or MBA) and/or professional certification (Preferred)
- 5 – 8+ years’ work experience in regulatory healthcare operations compliance (Required)
- Thorough knowledge of State and/or Federal programs operations and regulations (Required)
- Proficiency in the use of Microsoft Office - Word, Excel, Access, PowerPoint, Outlook, Teams, etc. (Required)
- Strong organizing, prioritizing, analytical, and problem-solving skills; and outstanding attention to details (Required)
- Proven ability to establish and maintain relationships of trust with departmental staff and management (Required)
- Proven ability to coordinate and lead interdepartmental work teams and meet established goals (Required)
- Must be goal oriented and able to meet tight deadlines while handling multiple priorities (Required)
- Must be a team player and able to take direction from multiple sources (Required)
- Proven ability to effectively manage multiple tasks/projects with competing priority levels/deadlines (Required)
- Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
- Ability to arrange work schedule to meet deadlines from multiple sources and engage staff throughout EmblemHealth to assist in the completion of duties (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.