Job Title:

Compliance Specialist (Medicaid/TennCare)

Number of Positions:

1

Location:

DDMI_Tennessee

Location Specifics:

Hybrid Position

Job Summary:

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 for all. 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 Compliance Program by ensuring the program effectively complies with relevant industry standards and regulations and identifies, prevents, detects, and corrects noncompliance.

Primary Job Responsibilities:

• Implement 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.

• Assist departments in requirements implementation, reporting, policy development and review, and readiness review preparedness.

• Collaborate with key departments to offer analysis, interpretation, training, and education on requirements to ensure comprehension and effective implementation of compliance standards.

• Advise organization and support Compliance Officer in communicating regulatory changes and implementation of compliance strategies to meet them.

• Facilitate and manage coordination between compliance department and operations on new compliance efforts and initiatives.

• Prepare and submit compliance reports, attestations, responses to internal and external stakeholders in a timely manner, ensuring accuracy and completeness.

• Maintain reports, data, responses, and other materials using compliance departments GRC system.

• Maintain and analyze company’s monitored compliance efforts and identify and assess gaps.

• Facilitate and coordinate audits, requests, or inquiries by collecting, reviewing, analyzing and verifying all requested materials prior to submission, including any collaborating with the applicable operational subject matter expert

• Develops and maintains successful relationships with internal/external stakeholders, including state regulators and external clients.

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

#LI-Hybrid

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 experience, preferably in the health 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 ability to process large quantities of detailed information with high levels of accuracy; ability to multitask and work on multiple projects at any given time; ability to analyze information and provide alternative solutions for problem solving; excellent interpersonal skills; effective verbal and written communication skills; attention to detail; ability to work under deadlines and change priorities on short notice.

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.