Compliance Specialist

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Imperial Management Administrators Services

Primary responsibility for collecting, tracking, monitoring and review of Regulatory Reporting from First, Tier, Downstream and Related Entities (FDR)s and internal functional areas. Provide administrative support to the Sr. Compliance Manager as it relates to website content and member and provider material reviews.

ESSENTIAL JOB FUNCTIONS:

1. Responsible for collecting, tracking, monitoring and review of regulatory reporting requirements to ensure that reports are submitted timely and accurately (e.g. required Centers for Medicare & Medicaid Services (CMS) and Part C and Part D monthly/quarterly reports).

2. Knowledgeable of CMS and State regulatory guidelines related to regulatory reporting and staying abreast to changes.

3. Develop and maintain a positive business relationships with all internal and external FDRs and Functional Areas and coordinate reporting requests.

4. Maintain regulatory reporting due dates.

5. Gather and research the necessary guidance for regulatory reporting.

6. Prepare data for submissions to regulators.

7. Support the Sr. Compliance Manager with regulatory reporting uploads.

8. Support the design, development, implementation and continued maintenance of the plan’s website.

9. Support internal and external member and provider material preparation including tracking, monitoring, review and approvals (e.g. Annual Notice of Change, Evidence of Coverage, Provider Directory, Pharmacy Directory, Drug Formulary, Summary of Benefits, Pre-Enrollment Kits).

10. Continually develop subject matter expertise across all operation areas. Ensure questions/issues that may arise are addressed timely and seek subject matter expertise from direct report, where applicable, in order to ensure responses are accurate.

11. Serve as back up for audits.
Direct administrative support to the Compliance department as it relates to daily compliance functions.

EDUCATION/EXPERIENCE:

·         High school graduate or equivalent.

·         Bachelor’s degree (BA or BS); or equivalent combination of education and experience.

 

·         2 years Regulatory Compliance experience or in lieu, two years working with CMS government program, including working knowledge of MAPD plan organization and structure.

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