Sr. Compliance Specialist

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

MAJOR RESPONSIBILITIES

  • Lead internal compliance audits of operational areas to ensure that the organization is meeting regulatory and client contract requirements.
  • Coordinate, respond and participate in external client audits and CMS and state regulatory audits.
  • Work with business owners in reviewing routine monitoring measures.
  • Develop appropriate compliance reports, including dashboards, tracking logs and summary reports that communicate the status of the compliance program to leadership.
  • Present reports and presentations before senior leadership, business owners and internal and external stakeholders.
  • Lead and remediate corrective action plans to remediate identified deficiencies. Investigate fraud, waste and abuse (FWA) cases.
  • Serve as project manager on various projects, including process improvement initiatives, corrective measures and new rule implementation. Work with outside entities, including vendors, CMS, external consultants and other health plan compliance professionals.
  • Assist the Compliance Officer in executing the annual compliance work plan.
  • Analyze regulatory updates, such as HPMS memos, federal register and the managed care manuals.
  • Train internal operational areas on compliance topics and operational requirements.

Qualifications

QUALIFICATIONS

  • Bachelor’s degree (required) with a field of study in business, healthcare or healthcare related, public policy, accounting preferred.
  • 3-6 years of health plan experience (required), with Medicare Advantage and Part D health plan experience preferred.
  • Experience with working in a healthcare compliance, audit or operations background preferred.
  • Knowledge of Medicare and CMS regulations preferred.

NECESSARY SKILLS

  • Strong written and oral communication skills
  • Strong analytical and critical thinking
  • Ability to act strategically as well as tactically
  • Ability to make independent decisions
  • Ability to learn independently with little supervision
  • Ability to manage multiple projects with changing priorities and timelines in a multi-tasking environment
  • Ability to give and receive honest feedback from peers and leadership
  • Extremely detailed oriented
  • Ability to work collaboratively with others through diplomacy and mutual respectful

Additional Information

All your information will be kept confidential according to EEO guidelines.