Regional Senior Compliance Analyst - Knoxville, TN - Full-time / Part-time

Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm)

Primary Responsibilities:

• Policies and Procedures
  
  
  
  • Maintains, and revises policies and procedures for the general operation of the Compliance Program and its related activities to prevent illegal, unethical, or improper conduct.
  
  
  • Assure policies and procedures are current and updated as necessary
  
  
  • Establish and enforce policies and procedures as part of corrective action plans developed


• Audit Responsibilities
  
  
  
  • Assist Compliance Officer with establishing standards, guidelines and indicators of compliance with policies and procedures in effect
  
  
  • Assist Compliance Officer with Establish and implement the Annual Audit Plan according to CMS standards, as well as applicable federal or local rules and regulations
  
  
  • Participate in Company risk assessment, audit planning, and scheduling processes
  
  
  • Coordinate audit activity with business management
  
  
  • Oversee audit activity
  
  
  • Responsible for developing and maintaining operational efficiency and effectiveness in accordance with Federal, State, & Local Guidelines as well as Delegation agreements
  
  
  • Institutionalize and standardize processes and practices within the audit
  
  
  • Develop an in-depth understanding of the organization, including key leaders, business drivers, issues, challenges, organizational structure, financial systems, control structure, policies and procedures
  
  
  • Establish and maintain professional and independent relationships with senior leadership of both internal and external clients
  
  
  • Assist Compliance Officer in developing a quantitative and qualitative risk assessment with key business owners
  
  
  • Ensure that audit issues are well defined, root causes are identified, and recommendations for improved internal controls and processes are communicated appropriately; as needed, provide leadership for the development and implementation of corrective action plans
  
  
  • Work with the Compliance officer to promote a strong control environment where fraud or noncompliance is unacceptable and difficult to conceal


• Education and Training
  
  
  
  • Conduct and coordinate compliance training to meet identified needs of Departments and individuals
  
  
  • Assist the Compliance Officer with developing an effective compliance training program, including appropriate introductory training for new employees and on-going training for all employees and managers, subcontractors, and first tier downstream and related entities
  
  
  • Ensure that all employees, subcontractor, and first tier downstream and related entities receive Compliance Training upon hire and annually thereafter


• Monitoring
  
  
  
  • Monitors and coordinates compliance activities throughout organization to ensure an effective program in accordance with rules and regulations
  
  
  • Conducts mock audits routinely throughout the calendar year. Report results to Compliance Committee
  
  
  • Develop and/or review at least annually the Compliance Calendar that is distributed to Business Owners and management
  
  
  • Assure daily compliance with CMS, State, Local and Delegated activities as applicable to regulations and request for actions


• Investigation
  
  
  
  • Collaborates with other departments to direct compliance issues to appropriate existing channels for investigation and resolution
  
  
  • Consults with the Legal Affairs Office as needed to resolve difficult legal compliance issues
  
  
  • Assists CO in responding to alleged violations of rules, regulations, policies, procedures, and code of conduct by evaluating or recommending the initiation of investigative procedures
  
  
  • Develops and oversees a system for uniform handling of such violations


• Subject Matter Expert
  
  
  
  • Assists in responding to other departments when compliance expertise, interpretations, opinions, advice or assistance is needed
  
  
  • Identify, analyze and offer strategies to management on products, operational risks based on or related to compliance issues; review the implementation of approved strategies
  
  
  • Keep informed regarding pending industry changes, trends, and best practices by participating in collaborative settings including ones that guide and lead the health industry
  
  
  • Act as a resource to all business owners and Leaders on Regulatory requirements


• Liaison
  
  
  
  • Liaison to CMS and other governmental agencies, as well as Delegate Compliance officers
  
  
  • Maintain relationships with all regulatory organizations and appropriate industry groups, forums and organizations
  
  
  • Participate in UM, QI, and Executive Operational Committee meetings as scheduled


• Others
  
  
  
  • Assists Compliance Officer in managing day-to-day operation of the Program
  
  
  • Oversee the marketing materials approval process and for communication with CMS
  
  
  • Establishes and provides direction and management of the compliance Hotline
  
  
  • Perform any other task or duty as requested and necessary to the organization's accomplishment of its goals and objectives

Required Qualifications:

• Bachelor's degree


• 5+ years related experience


• Knowledge and experience in information privacy laws, access, release of information, and release control technologies


• Knowledge of Health Care Regulatory standards


• Knowledge of Government Program regulatory guidelines


• High integrity


• Excellent organizational and analytical skills.  Ability to work well both independently and with others in a matrix environment


• Excellent judgment


• Strong influencing skills and perseverance in investigating


• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedure, governmental regulations, and legal documents 


• Excellent oral and written communications skills; ability to write clear, concise reports, business correspondence, and procedures


• Ability to effectively present and represent the company's interests externally with regulators


• Ability to effectively present information and respond to inquiries from employees, regulators agencies, and others, as necessary


• Ability to initiate administrative activities as necessary and institute quality control procedures


• Ability to meet deadlines and adjust to changes in company policies, procedures, and priorities


• Intermediate MS Excel, Internet, MS Power Point, & Word Processing skills


• Ability to travel independently 50% of their scheduled time

Preferred Qualifications:

• Master's degree


• Previous state or federal regulatory or managed care compliance experience


• Professional work experience with/for Federal & State Agencies, Health Care related


• Direct experience with Start-Up Departments, Infrastructures


• Flexible, Motivated by Challenges; Creative; Interpersonal Skills  

North American Medical Management specializes in working with leading physicians and hospitals to successfully manage the delivery of medical services. We have developed sophisticated techniques for managing the revenue and health care expenses of medical groups. NAMM currently provides MSO services to twelve PHOs and IPAs in the Chicago area serving about 90,000 managed care lives with positive results

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: compliance, regulatory, legal, regulations, healthcare, health, insurance, audits, marketing, privacy, Knoxville, TN, Tennessee