Compliance Consultant III Aurora, CO
Researches, plans, implements, and monitors a broad portfolio of Medicare managed care compliance systems and initiatives to enable organizational compliance with all applicable Federal, state, and local regulations/laws, as well as overseeing the protection of organizational assets. On an on-going basis, researches and interprets regulations and laws to establish compliance standards, and may develop and/or deliver training and communications/change management relative to new standards. Assesses organizational systems (both physical and process or data related) to determine gaps in compliance and determine opportunities for remediation. Advises the organization on all Medicare contract compliance matters. May investigate violations of compliance policy, laws, regulations, etc. or conduct on-going monitoring and reporting to ensure remediation. May be responsible for project management relative to new compliance initiatives, products, or annual processes.
- Manages, creates, and maintains client relationships.
- In adherence with the KP Compliance Framework, fosters comprehensive compliance management through a series of activities to comply with all applicable regulations and statutes. Activities include: Planning: identifying compliance accountabilities; identifying internal and external resources; developing Compliance, Work, and Audit plans; participating on and may establish compliance-related committees/work groups; and managing external agency relations. Implementing: identifying compliance requirements and conducting related analyses; creating or revising compliance standards, policies, and procedures; developing and/or conducting compliance and ethics training; monitoring compliance adherence; and reporting on compliance efforts and programs. Validating: reviewing compliance programs and content, including designing and conducting risk assessments and/or audits, and investigating instances of reported non-compliance.
- Researches and stays abreast of regulations and statutes. Determines impacts of implementation of new regulations and statutes and required notifications, changes, and training. Communicates required changes, develops tools to assess risks, and leverages existing workgroups/etc. to facilitate required changes.
- Minimum five (5) years of health care compliance, health care operations (quality, risk, etc.), audit, finance, project management, regulatory or public policy development, investigations, information security, or insurance/health plan governance experience.
- Bachelor's or clinical degree, OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
Licenses, Certifications, Registrations
- Thorough knowledge of health care compliance policies, practices and systems.
- Thorough knowledge of health care and related compliance issues.
- Complete understanding of compliance principles, theories, and concepts.
- Full knowledge of health care industry practices and standards.
- Ability to draft and revise documents including policies, standards, analyses, and reports.
- Project management skills.
- Must be able to work in a Labor/Management Partnership environment.
-Knowledge of Medicare rules and regulations for Medicare health plans.
-HCCA Certification or willingness to achieve a future date.
-Strong verbal and written communication skills and proven ability to draft and revise.
Primary Location: Colorado,Aurora,Waterpark I 2500 S. Havana St.
Scheduled Hours (1-40): 40
Working Days: Mon - Fri
Job Type: Standard
Employee Status: Regular
Employee Group: Salaried, Non-Union, Exempt
Job Level: Individual Contributor
Job: Compliance / Privacy / Regulatory
Public Department Name: National Compliance Ethics & Integrity Office
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.
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