Compliance Project Specialist I/II- 004941 at Excellus Health Plan Inc. in binghamton, New York

Job Description:

Summary

Level I
Responsible for ensuring that all areas of the Division are in compliance with local, state and federal regulations contractual agreements and Association mandates. Collaborates with Operational business areas to identify and improve processes that are not compliant and implement new regulations.

Level II
In addition to level I responsibilities, the second level will handle more complex and higher profile issues that may require immediate action. Experience is demonstrated through efficiency and independence of work.

Level III
In addition to level II responsibilities, this level is a seasoned and certified Project Manager and is responsible for division wide and high profile projects. Manages multiple projects at the same time.

Essential Responsibilities/Accountabilities
Level I
• Reviews documentation from regulatory agencies that the Division must comply with. Refers to and Corporate Compliance department and Legal division for counsel and support, as necessary.
• Acts as the liaison between Corporate Legal, Government Programs and Compliance and the Division.
• Researches and investigates all non-compliant functions as well as recommends whether corrective action is required.
• In areas that may not be compliant, the position directs projects and improves processes from end to end (identification through post-implementation) to ensure compliance with regulations, contracts and mandates. This may include holding meetings, analyzing data, working with business owners from within the Division as well as other operating teams impacted by the business decision.
• Engages auditing bodies to ensure high risk "fixes" or new implementations are functioning according to regulation, contract and/or mandate.
• Interprets and trends customer, group and provider data to identify problems and recommend resolution and enhancements.
• Coordinates feasibility studies, proposes development, enhancement and/or maintenance of operational processes as warranted. Processes and enhancements include personnel and transaction activities related to different functional areas of the division.
• Observes and interviews individuals as well as conducts focus groups to ensure that changes in transaction processing and customer interactions are operating effectively and compliant.
• Collaborates with management in the development of projects and processes to arrive at solutions to compliance issues.
• Prepares reports and makes detailed presentations to project teams, department heads and all levels of management related to compliance issues and their resolution.
• Assists the Compliance Delegate at regular Compliance Committee and managing/supporting any compliance issues for Divisions outside of the committee.
• Provides management with regular status reporting on all projects/initiatives.
• Works with functional area experts to ensure Compliance goals are achieved. This position has critical objectives to ensure that the Health Plan is meeting all Compliance guidelines and Performance Standards. If not adhered to, Corporation could be at risk for penalties and fines.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct, and Leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Level II - Performs similar functions as the level I and is additionally responsible for:
• Leads staff in the execution of process improvements.
• Takes on more complex and higher profile projects.
• Leads teams to evaluate and drive best business practices to reduce the Health Plan's risk of penalties and fines for not meeting Compliance regulations.

Level III - In addition to level II responsibilities:
• Represents managers and directors of supported areas pertaining to all related projects including decision making responsibilities, attendance at corporate and divisional committees, meetings and workgroups.
• Determines, monitors, and reviews all project economics to include project costs, operational budgets, staffing requirements, project resources, and project risks. Identifies and assembles the appropriate blend of talent and additional resources to meet project needs and requirements.
• Formulates contingency plans to address schedule revisions, manpower adjustments, fund allocations, and work requirements. Ensures adherence to legally binding requirements and customer long-term strategic goals. Controls project requirements, scope and change management issues.
• Coaches and counsels members of cross functional teams to accomplish projects, meet established schedules, or resolve technical/operational issues.
• Manages multiple project teams under the governance of the Microsoft Framework Solution Team Process Methodology.
• Guides and mentors more junior Compliance Project Specialists.

Minimum Qualifications

NOTE:
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

Level I
• Bachelor's degree in relevant field with a minimum of three years of progressive experience in project management and considerable operational knowledge of multiple functional areas. In lieu of a degree, a minimum of six years of progressive project management/process improvement work experience and operations knowledge is required.
• Must have solid communication skills - both verbal and written.
• Strong Project management skills and ability to multi-task. Able to lead teams and drive results.
• Strong analytical skills and the ability to recommend solutions to problems.
• Ability to work well with all levels of Management
• Has a thorough understanding of business areas which may include Government Programs, Claims, PFM, Customer Service, and Membership and Billing guidelines, procedures and requirements.

Level II (in addition to qualifications in level one)
• Bachelor's degree and minimum 5 years relevant experience (in lieu of a degree, 8 years experience).
• Demonstrated expertise in project management and project leadership.
• Thorough understanding of regulatory environment.

Level III (in addition to qualifications in level two)
• Bachelor's degree and minimum 5 years progressive project management experience (in lieu of a degree, 8 years relevant experience).
• Considerable experience in project management and project leadership.
• Able to handle more complex and higher profile projects.
• PMI, PMP or Lean Six Sigma Certification is required at this level.

Physical Requirements
Use of a computer, phone, and travel across all Health Plans is essential.

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The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun! We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer