What are the responsibilities and job description for the Compliance Specialist position at Group Health Cooperative of South Central...?
POSITION SUMMARY
The Compliance Specialist is responsible for gathering and maintaining company data to support the creation and submission of documents related to important business functions and adherence to State of Wisconsin and Federal laws and regulations. The incumbent is content owner of, and responsible for the maintenance, administration and support of a variety of third party software systems and electronic portals including but not limited to: SERFF, HIWA, and HIOS. The incumbent is responsible for the use and maintenance of BenefitHub, an internally developed system for managing Plan data and which creates and links plan documents (certificates, amendments and riders, benefit summaries, SBCs, etc.) The incumbent is the primary owner and coordinator responsible for preparing and submitting GHC-SCW’s Qualified Health Plans (QHP) application, including completion of necessary templates and data integrity processes. The position is also responsible for creating technical documents necessary for State filings including Certificates of Insurance, Benefit Summaries, and Summaries of Benefits and Coverage, and for completing and submitting necessary reports to GHC-SCW’s oversight entities. The position requires extensive collaboration with other members of the Compliance Department as well as departments throughout the organization. The incumbent should possess excellent written communication skills, moderate to advanced knowledge of Microsoft Office products (Excel, Word, etc.), and a strong attention to detail. The position works under general guidance and supervision of the Chief Compliance Officer with moderate latitude for the use of initiative and independent judgment.
MINIMUM JOB SPECIFIC QUALIFICATIONS
1. Bachelor’s degree from an accredited college or university. This qualification may be met with extensive relevant work experience; or equivalent combination of education and experience.
2. A minimum of three (3) years, five (5) years preferred, relevant professional work experience involving data gathering, analysis, and related information systems required. Experience within healthcare insurance and/or healthcare delivery system preferred.
3. Ability to research, interpret, understand, and apply technical directions, policies, and regulations via sound judgment and critical thinking required.
4. Knowledge of and proven proficiency in the use of Microsoft Office applications including extensive knowledge of Excel, Word, Outlook, and Power Point.
5. Ability to learn and effectively utilize multiple computer systems and reporting software used to fulfill job responsibilities.
6. Ability to manage multiple interim initiatives, priorities, and problems to achieve a larger objective required.
7. Ability to lead and direct collaborative teams, uniformity of design, and subject matter knowledge.
8. Ability to maintain poise and accurate work product in high-pressure situations requiring deadline driven work.
9. Ability to proofread documents and forms for spelling, grammar, formatting, and clarity. Knowledge and proficiency with English punctuation, grammar, and spelling.
10. Accurate data entry skills and attention to detail.
11. Ability to identify potential errors in data based on business rule application, uniformity of design, and subject matter knowledge.
12. Ability to communicate ideas and instructions clearly, concisely and consistently, both verbally and in writing, to different audiences.
13. Ability to make independent decisions based on facts, circumstances, and organizational needs.
14. Fine manual dexterity required. Ability to use a keyboard extensively.
15. Outstanding verbal and written communication skills including ability to provide telephone support to collaborate courteously and effectively with internal stakeholders, external parties, compliance and regulatory officials, practitioners, and the general public. Ability to be culturally sensitive and work with diverse populations.
16. Ability to maintain organizational, personnel related, and patient confidentiality. Knowledge of or ability to learn HIPAA privacy requirements.
17. Ability to be flexible and adaptable to changing priorities and assignments.
18. Ability to work independently and be results oriented. Ability to design general correspondences, memos, charts, tables, graphs, etc.
19. Ability to bend, reach, lift, pull, and carry up to 20 lbs regularly required.
20. Ability to speak and listen in person and on the phone required.
21. Demonstrated ability to work with multi-disciplinary groups, including those external to GHC-SCW, and to represent GHC-SCW in a professional manner.
The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.
Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.
Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.
Our Values
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.
We are better together.
GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
The Compliance Specialist is responsible for gathering and maintaining company data to support the creation and submission of documents related to important business functions and adherence to State of Wisconsin and Federal laws and regulations. The incumbent is content owner of, and responsible for the maintenance, administration and support of a variety of third party software systems and electronic portals including but not limited to: SERFF, HIWA, and HIOS. The incumbent is responsible for the use and maintenance of BenefitHub, an internally developed system for managing Plan data and which creates and links plan documents (certificates, amendments and riders, benefit summaries, SBCs, etc.) The incumbent is the primary owner and coordinator responsible for preparing and submitting GHC-SCW’s Qualified Health Plans (QHP) application, including completion of necessary templates and data integrity processes. The position is also responsible for creating technical documents necessary for State filings including Certificates of Insurance, Benefit Summaries, and Summaries of Benefits and Coverage, and for completing and submitting necessary reports to GHC-SCW’s oversight entities. The position requires extensive collaboration with other members of the Compliance Department as well as departments throughout the organization. The incumbent should possess excellent written communication skills, moderate to advanced knowledge of Microsoft Office products (Excel, Word, etc.), and a strong attention to detail. The position works under general guidance and supervision of the Chief Compliance Officer with moderate latitude for the use of initiative and independent judgment.
MINIMUM JOB SPECIFIC QUALIFICATIONS
1. Bachelor’s degree from an accredited college or university. This qualification may be met with extensive relevant work experience; or equivalent combination of education and experience.
2. A minimum of three (3) years, five (5) years preferred, relevant professional work experience involving data gathering, analysis, and related information systems required. Experience within healthcare insurance and/or healthcare delivery system preferred.
3. Ability to research, interpret, understand, and apply technical directions, policies, and regulations via sound judgment and critical thinking required.
4. Knowledge of and proven proficiency in the use of Microsoft Office applications including extensive knowledge of Excel, Word, Outlook, and Power Point.
5. Ability to learn and effectively utilize multiple computer systems and reporting software used to fulfill job responsibilities.
6. Ability to manage multiple interim initiatives, priorities, and problems to achieve a larger objective required.
7. Ability to lead and direct collaborative teams, uniformity of design, and subject matter knowledge.
8. Ability to maintain poise and accurate work product in high-pressure situations requiring deadline driven work.
9. Ability to proofread documents and forms for spelling, grammar, formatting, and clarity. Knowledge and proficiency with English punctuation, grammar, and spelling.
10. Accurate data entry skills and attention to detail.
11. Ability to identify potential errors in data based on business rule application, uniformity of design, and subject matter knowledge.
12. Ability to communicate ideas and instructions clearly, concisely and consistently, both verbally and in writing, to different audiences.
13. Ability to make independent decisions based on facts, circumstances, and organizational needs.
14. Fine manual dexterity required. Ability to use a keyboard extensively.
15. Outstanding verbal and written communication skills including ability to provide telephone support to collaborate courteously and effectively with internal stakeholders, external parties, compliance and regulatory officials, practitioners, and the general public. Ability to be culturally sensitive and work with diverse populations.
16. Ability to maintain organizational, personnel related, and patient confidentiality. Knowledge of or ability to learn HIPAA privacy requirements.
17. Ability to be flexible and adaptable to changing priorities and assignments.
18. Ability to work independently and be results oriented. Ability to design general correspondences, memos, charts, tables, graphs, etc.
19. Ability to bend, reach, lift, pull, and carry up to 20 lbs regularly required.
20. Ability to speak and listen in person and on the phone required.
21. Demonstrated ability to work with multi-disciplinary groups, including those external to GHC-SCW, and to represent GHC-SCW in a professional manner.
The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.
Our Mission Statement: We partner with members and the communities we serve to maximize health and well-being.
Our Vision: As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.
Our Values
- We are a not-for-profit Cooperative
- We are member-centered
- We are equitable and inclusive
- We are quality-driven
- We are innovative
- We are community involved
Healthcare is a human right.
In treating all people with dignity and respect.
There is strength in diversity.
Equity celebrates our humanity.
We are better together.
GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
