What are the responsibilities and job description for the Senior Compliance Specialist position at Scan?
SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 270,000 members in California, Arizona, Nevada, Texas & New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided with in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare visit www.thescangroup.org, www.scanhealthplan.com, or follow us on LinkedIn, Facebook, and Twitter.
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The job
Ensure regulatory compliance for assigned plan functional areas by acting as a consultative subject matter expert and monitoring performance against federal regulations. Recommend process improvements and corrective actions to achieve and maintain compliance.
You will
- Manage the intake, investigation, and resolution of Complaints Tracking Module (CTMs) received from CMS. Review and approve marketing and communication materials for Medicare programs.
- Serve as the Compliance Lead for designated plan functional area(s), as assigned by Manager, Medicare Compliance. Provide compliance and regulatory expertise to assigned areas, ensuring adherence to federal regulations and planning contractual requirements through consultative support.
- Offer interpretation and guidance on federal regulations and sub-regulatory requirements (e.g., HPMS memos, CMS Communications, Medicare Managed Care Manuals, CMS final rule, etc.) and policies impacting assigned areas. Regularly review and assess monitoring metric results, performance reports, operating practices, and other available resources to oversee assigned functional area(s).
- Analyze legislation, federal regulations, and policies, and provide actionable guidance to ensure compliance. Lead workgroups to implement changes driven by new or updated regulations, identifying high-risk areas and ensuring effective action.
- Recommend new or revised policies and processes to uphold regulatory standards. Advise on ways to improve regulatory performance and increase efficiency. Prepare compliance reports by analyzing data, identifying trends, and presenting findings.
- Develop and deliver training presentations for assigned functional areas. Uphold the company's reputation by ensuring regulatory compliance in partnership with staff and departments.
- Stay current with professional knowledge through education, workshops, and professional networks. Maintain confidentiality to protect operations.
- All other duties as assigned.
Minimum Qualifications
Skills / Abilities
What’s in it for you?
An opportunity to become part of a team that makes a difference to our members and our community every day!
We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!
At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.
SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.
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Salary : $64,000 - $102,400
