Clinical specialist Jobs in Lansing, MI

Compliance Specialist

At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.

At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do from taking charge of our careers, to helping colleagues and lending a hand in the community.

Position Description

To provide support for the day-to-day operations and management of the Compliance Program with respect to Delta Dental of Michigan and its affiliates and/or subsidiaries.

Primary Job Responsibilities:

• Implements initiatives to raise awareness of Company's Compliance Program including planning, developing and conducting education and training activities related to compliance.
• Responsible for the development of training materials, implementation of training calendar, monitoring and auditing employee training records.
• Monitors and evaluates documents to determine the relevance of regulatory updates that may affect member materials. Responsible for monitoring document revision processes, ensuring that changes are implemented from initial request through approval by internal and external parties and verifying the accuracy of final production. Provides consistent updates to management and relevant stakeholders on the status of document implementation and highlights any risks related to timely and accurate implementation.
• Manages and maintains a document repository of member and provider documents, to ensure that forms are consistent with company standards, and legal, contractual and regulatory requirements.
• Responsible for working with internal and external stakeholders to ensure work is prioritized and implemented by the required deadline.
• Acts as a liaison for the compliance department, collaborating with key departments to confirm policies and procedures are developed and implemented to ensure compliance with applicable contract provisions, rules and regulations, including the assessment, interpretation and drafting of policy, procedure or job aids.
• Advises organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them.
• Facilitates and manages coordination between compliance department and operations on new compliance efforts and initiatives.
• Plays a key role in the annual compliance risk assessment and collaborate to ensure proper auditing is conducted and management of identified risks is appropriate.
• Maintains and analyzes company's monitored compliance efforts and identify and assess gaps.
• Coordinates various committees and task forces related to company's compliance, including management of assignments.
• Facilitates and coordinates all aspects of any Medicare Advantage, Medicaid or Affordable Care Act audit, request, or inquiry by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaborating with the applicable operational subject matter expert that may be required as a result of the request.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.

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Minimum Requirements:

Position requires a bachelor's degree in business administration, health administration, public health/public policy or a related field and three years of compliance or regulatory experience, preferably in the health or insurance industry or five years' experience related to auditing, quality monitoring, risk management, or operations. Compliance experience within the Medicare or Medicaid industry preferred. A compliance certification is preferred. Will accept any suitable combination of education, training, or experience.

Position requires the capability to process substantial amounts of detailed information with a high degree of accuracy; ability demonstrate strong analytical skills, efficiently manage multiple projects and effectively analyze data to develop alternative solutions; excellent interpersonal, verbal, and written communication skills; strong attention to detail and adaptability to shifting priorities and deadlines; strong organizational skills and proficiency in handling competing demands; and the ability to work independently and collaboratively within a fast-paced team environment.

The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.