Compliance Business Partner Jobs

Job Details

Job Location

Smithfield, RI - Smithfield, RI

Position Type

Full Time

Education Level

Bachelors Degree

Travel Percentage

None

Job Shift

Daytime

Job Category

Professional / Experienced

Description

The Compliance Business Partner (CBP) is responsible for aligning business objectives by providing regulatory support and compliance oversight for designated departments across the organization. The CBP will partner with the staff and leadership of assigned departments to identify compliance risk and issues of noncompliance, oversee correction of noncompliance, and provide regulatory interpretation.

The CBP assesses and anticipates Compliance-related needs and communicates needs proactively business management to seek and/or develop integrated solutions to mitigate risk. Using both formal and informal risk assessments, results of compliance monitoring and auditing, and other intel, this role will seek to assess compliance with policies and procedures, federal and State contracts, and laws and regulations as they pertain to accepted industry standards.

Duties And Responsibilities

Responsibilities include, but are not limited to, the following:

• Maintains in-depth knowledge of legal requirements related to compliance, reducing legal risks and ensuring regulatory compliance. Partners with the legal department as needed/required.
• Take responsibility for professional development, support a learning environment, and meet professional competency requirements.
• Follows up, verifies, and evaluates the adequacy of post-audit corrective actions by re-examining procedures, observing revised processes and conducting follow-up audits, where necessary
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
• Other duties as assigned
• Establishes, builds, and fosters relationships with assigned departments and all levels of the organization
• Performs formal and informal risk assessments to identify compliance risk
• Identifies compliance training needs for Organization and business units
• Develops, tracks, and monitors internal audit corrective action plans to ensure that the organization is fully implementing required action plans
• Collaborates with operational areas to develop and implement an internal regulatory compliance framework to promote compliance with laws, rules, and regulations that govern Neighborhood’s business activities
• Complies with all guidelines established by the Centers for Medicare and Medicaid Services (CMS) and guidelines set forth by other regulatory agencies, where applicable
• Participate in department continuous quality improvement activities
• Conducts regular meetings with respective business units
• Monitors business area performance against regulatory requirements
• Provides interpretation of new, changed, or existing regulatory and contractual requirements Assess potential impacts resulting from new or changed regulatory and contractual requirements

Qualifications

Qualifications

Required:

• Minimum of four (4) years experience working in a healthcare regulatory environment, with at least one (1) year working in a compliance role
• Bachelor’s Degree in health care or business-related discipline or sufficient experience and/or background to equate to the degree
• Proven organizational skills and attention to detail
• Ability to take direction and support a multitude of individuals
• Project management experience
• Builds Strong Relationships: Actively networks within the organization, building high quality relationships with management and line staff.
• Personal Drive to Succeed: Has ambition that is appropriately displayed through the quality of their work. Individual is driven by a strong internal desire to have impact and influence in the organization.
• Excellent written and verbal communication skills
• Effective written and verbal communication, ability to present control analysis and recommendations with clarity and professionalism
• Strong interpersonal skills and customer service orientation
• Ability to prioritize tasks effectively and work independently
• Ability to maintain confidentiality
• Ability to think analytically, communicate complex issues and develop control recommendations

Preferred:

• Two (2) to Four (4) years’ experience working in the area of health insurance compliance including Medicare or Medicaid compliance
• Detailed knowledge of government healthcare program regulations including the ability to read contracts
• Working knowledge of CMS/EOHHS rules and regulations and familiarity with compliance tools (e.g., OMT/Gorman Tool)

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.