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Independent Health Specialist - Compliance, Contracting & Regulatory in Williamsville, New York

Overview

The Compliance, Contracting & Regulatory Specialist shall be responsible for the overall execution and monitoring of vendor contracts, business and professional licensing and regulatory filing, compliance policies and the overall administration of programs in effect to ensure companywide adherence to laws and regulations.The Compliance, Contracting & Regulatory Specialist will be the liaison between Nova business units, the Independent Health Compliance and Vendor Contract Management, Facilities and Finance departments. The individual will capture, define and understand the business needs of Nova and will work to ensure those needs and interests are appropriately represented.

Responsibilities shall include initial and renewal of corporate licensure, advisement and monitoring of insurance, professional, and clinical licensure, drafting and reviewing vendor contracts, business documents, forms and communications and managing certain compliance tasks, and conducting regulatory research. The position will work closely with the Operations Management team, Clinical Management team and Finance/Accounting Management team to assist with Nova’s compliance with all applicable federal and state laws and regulations impacting Nova’s business as a third party administrator and Nova’s group health plan clients. Additionally, this position will serve as the liaison between Nova and Independent Health with respect to Nova’s Compliance Plan. Any needed legal support to Nova shall be under the direction and oversight of an Independent Health Senior Deputy Counsel and/or Legal Department team member.

Qualifications

  • Associate’s degree required; Bachelor’s degree preferred. An additional two (2) years of relevant experience will be considered in lieu of a degree.

  • Three (3) years of corporate legal, audit, contract management, employee benefits or compliance experience required; healthcare experience preferred.

  • Experience with self-funded group health plans preferred.

  • Advanced computer and Windows skills required. Experience with Microsoft Office applications, and demonstrated ability to learn new software applications.

  • Excellent research skills and exercise independent judgement to determine which changes in regulatory landscape should be presented in collateral and trainings and/or referred to Independent Health’s Legal or Compliance Departments. Strong decision-making skills required.

  • Excellent analytical skills, ability to analyze components of legislation and implement and draft necessary policies and procedures based upon regulatory requirements.

  • Excellent composition and drafting skills, with emphasis on various compliance/regulatory documents and correspondence.

  • Excellent communication skills, both verbal and written, and excellent interpersonal skills.

  • Ability to effectively build and maintain relationships with both internal and external stakeholders.

  • Possess initiative, creativity, project management and organizational abilities.

  • Proven examples of displaying the Nova values: Passion, Caring, Trustworthy, Collaborative, Respectful and Accountable.

Key Accountabilities

Research and Monitoring of Laws & Regulations

  • Research, define, capture and understand the business needs to support the review, negotiation and execution of all registrations, licenses, agreements and contracts for Nova.

  • Research statutes and federal regulations concerning TPA, insurance adjuster, utilization review, and other applicable requirements related to the TPA business; and monitoring and tracking for any changes or updates.

  • Research and maintain an understanding of compliance obligations of clients, including, but not limited to: ERISA, HIPAA, COBRA, and Health Reform, and shall report to Manager who will decide on recommendations to client account management to communicate, as appropriate.

  • Vendor Contract Compliance:

  • Facilitate and oversee the contracting process for all vendor agreements.

  • Develop, implement and maintain tracking and monitoring processes to ensure vendor compliance with contract terms and conditions.

  • Facilitate the timely review and renewal of all contacts as necessary.

  • Facilitate coordination with Independent Health Legal and Vendor Contracting departments.

Licensing and Registrations Monitoring

  • Research application and regulatory requirements for Nova to obtain and maintain licensure or business registration in various states in which Nova conducts or wishes to conduct business.

  • Complete and facilitate all necessary application and documentation requirements for the timely submission of all initial and renewal license and/or registration applications.

  • Develop and maintain tracking and monitoring processes to ensure compliance with business operations, application, and renewal requirements, including coordination with other departments for professional, sales and clinical licensure.

  • Coordinate with Nova Finance/Accounting department as appropriate.

  • Coordinate with Independent Health Finance department and/or corporate administrative professionals as required to facilitate Board of Directors and Executive Team compliance with federal and state requirements for Nova and self-funded business.

Corporate Compliance & Information Risk Monitoring

  • Participate in Independent Health’s corporate affiliate compliance meetings to address compliance, privacy and security matters as required.

  • In coordination with Corporate Compliance, facilitate affiliate compliance committee agenda items that are related to self-funded plans.

  • Serve as the primary Nova representative and liaison between Nova business units and Independent Health Compliance team supporting the business.

  • Serve as the Nova representative for the review, coordination and reporting of any issues requiring Independent Health Compliance assistance or involvement; assist in investigation, follow-up, retraining, issuance and monitoring of corrective action plans.

  • With support from Independent Health’s Corporate Compliance department, provide explanation and disseminate Nova’s compliance program requirements and communications throughout the organization and as necessary to external entities. Annually review and update existing Compliance program policies and processes, verify accuracy of legal citations in policies, and conduct regulatory research as required to support compliance program operations. Develops, fosters, and matures compliance program process efficiencies with the goal of reducing time and effort to perform.

  • Support Nova’s adherence to Information Risk privacy and security. Facilitate, report and assist in the reporting of any privacy and security risk to IRO and provide support to ensure all complaints handled diligently and appropriately, performing privacy reviews, conducting monitoring activities for acceptable use, assisting with any federal or state government investigations and coordinating and performing associate retrainings of Nova privacy events.

  • Serve as point of contact and front-line support at Nova to respond/triage associate compliance or privacy and security questions, receive and report Nova associate conflict of interest, compliance reports/concerns.

  • Support Nova associate education and awareness for compliance, privacy and security through dissemination of policies, including organization-wide privacy policies and procedures, code of conduct along with Corporate compliance communications including but not limited to: annual Compliance Training Notices, Quarterly Compliance Newsletters, etc.; assist with coordination of training efforts for ongoing and annual training requirements for compliance, privacy and security, as well as promote and help coordinate activities to foster privacy awareness and compliance within the organization.

  • Coordinate with Independent Health Facilities and/or corporate Finance to maintain adequate insurance and bonding, as required.

As an Equal Opportunity / Affirmative Action Employer, Independent Health and its affiliates will not discriminate in its employment practices due to an applicant’s race, color, creed, religion, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, physical and mental disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, a disabled, special, recently separated, active duty wartime, campaign badge, Armed Forces service medal veteran, or any other characteristics protected under applicable law. Click here (https://www.independenthealth.com/AboutIndependentHealth/Careers/AdditionalEEO-AAPInformation) for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via their Career Worklet.

Independent Health, a not-for-profit health plan headquartered in Buffalo, NY, serves nearly 400,000 members and provides innovative health care products and benefits designed to engage consumers in their health and well-being. Established in 1980, our comprehensive portfolio of progressive products include HMO, POS and EPO products, Medicare and Medicaid plans, traditional indemnity insurance, individual and small group Exchange products, consumer-directed plans and health savings accounts, plus coverage for self-funded employers.

Independent Health has augmented its highly successful insured product portfolio with services employers and employees need to better manage their health care expenses through its affiliate companies, including the Independent Health Foundation, Pharmacy Benefit Dimensions, Reliance Rx, Nova Healthcare Administrators, and DxID.

Our award-winning customer service, dedication to quality health care and unmatched relationships with physicians and providers has allowed us to be consistently recognized as one of the highest-ranked health insurance plans in the nation.

We do not accept resumes from headhunters, placement agencies, or other suppliers that have not signed a formal agreement with us.

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