Full Job Description
The Business Relationship Specialist in the Clinical Regulatory Compliance team is responsible for promoting compliance with regulatory requirements within Healthfirst's Clinical Operations, Appeals and Grievances, and delegated vendor operations departments.
Supports regulatory and compliance activities of business unit’s clinical and related operations.
Meets with the Regulatory department to organize deliverables and reviews materials.
Interacts with and represents clinical departments to internal auditors and coordinates responses to internal and external auditor requests.
Identifies organizational risks and helps implement process improvements.
Supports and participates in the implementation of contract changes for all lines of business pertaining to assigned clinical department. Ensures that all process and contract changes are reflected in departmental policies and procedures.
Reviews Healthfirst policies, procedures, and job aids to ensure compliance with CMS and DOH regulations.
Supports all Corrective Action Plans (CAPs) through completion.
Reviews timeliness of all monitoring reports to assess for compliance with regulatory time frames and develops CAPs for same if out of compliance.
Assists in regulatory audits, submissions, surveys, and internal audits.
Additional duties as assigned.
Associates from an accredited institution
Ability to work independently and to manage multiple tasks and responsibilities
Strong communication skills, experience preparing and delivering information to multiple audiences
Ability to work in a fast-paced environment
Experience in managed care or the healthcare industry
BA or BS from an accredited institution
Previous relevant compliance experience
Experience creating and analyzing reports
Excellent time and project management, communication, critical/creative thinking, and problem-solving skills
Intermediate Outlook, Word, Excel, and PowerPoint skills including creating spreadsheets, pivot tables, queries, and formulas
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
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