Regulatory Compliance Administrator

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team. Network Health is seeking a Regulatory Compliance Administrator I who will assist the Manager of Compliance and the Compliance Officer with updating, enhancing and administering all aspects of the Compliance and Integrity Program.

The incumbent will provide auditing and review assistance for all aspects of operations and compliance initiatives and will assist in improving the internal control environment at Network Health. The Regulatory Compliance Administrator I will further be responsible for the identification of risk areas and implementation of contract requirements to ensure compliance with applicable laws and regulations. The Regulatory Compliance Administrator I will report findings, recommend improvements and corrective actions.

Duties:

• Assist in developing compliance audit instruments and protocols; revise policies and procedures; design, implement and conduct adequate training under the direction of the Compliance Officer comply with regulatory changes.
• Responsible for the management and retention of key business documents in accordance with document retention guidelines as well as Network Health's record retention policy.
• Assist with implementation of the monitoring and auditing plan for all operational areas; serve as an additional on-site compliance resource for Network Health, consulting with the Compliance Officer where appropriate.
• Maintain Compliance intake forms, respond timely and appropriately to issues raised, and track any corrective actions necessary.
• Assist in evaluating the adequacy and effectiveness of internal controls for compliance with regulatory requirements.
• Assist with developing and implementing tools and procedures for assessing the risk of operations and applicable vendors that perform administrative functions on behalf of Network Health.
• Responsible for reviewing materials intended for members, agents and/or providers to ensure materials meet all requirements outlined by the State and Federal regulations.
• Responsible for facilitating, gathering and submitting data and other documentation from operational areas for external audit and data validation requests.
• Conduct audits of all departments involved in the delivery or administration of Network Health's insurance plans for compliance with State, Federal and Network Health standards
• Perform internal compliance investigations and assess operational risk

Requirements:

• Associate Degree or four years of related experience required; Bachelor's Degree preferred.
• 1+ year of compliance or similar regulatory experience required.
• 1+ year of experience working with claims processing/monitoring, system configuration, pharmacy, enrollment, finance and/or appeals and grievance related position required.

Skills:

• Strong verbal, written, research and analytical skills
• Exceptional project management and interpersonal skills
• Strong attention to detail
• Must be self-motivated, able to work independently
• Must be able to work effectively with highly interdisciplinary teams

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.