Upper Peninsula Health Plan

Assists the Compliance Officer in ensuring the effective and successful implementation and maintenance of the Compliance Program. The position aids in identifying, documenting, and addressing potential compliance issues. The Compliance Associate will perform operational reviews to assess provider, vendor, and Plan compliance; guide special projects; and compile results and reports for the Compliance Officer. Provides support to the Special Investigations Unit (SIU). 

1. Follows established Upper Peninsula Health Plan (UPHP) policies and procedures, objectives, safety standards, and sensitivity to confidential information.

 

2. Assists the Compliance Officer by researching new and existing laws and regulations and works with affected departments within UPHP and vendors, as applicable, to gain understanding and implement as required.

 

3. Thoroughly documents compliance related activity and keeps department tracking tools and systems up to date with the status of all assigned items.

 

4. Assists the Compliance Officer with compliance and regulatory activities on an ongoing basis; reports any identified compliance issues or gaps to the Compliance Officer.

 

5. Attends assigned meetings and provides administrative support as requested or required. 

 

6. Maintains application(s) supporting the compliance program. 

 

7. Submits files to stop loss insurance carrier as required. Assists with document and contract management; provides filing and administrative support.

 

8. Assists with vendor oversight, including coordinating meetings, ensuring performance evaluation completion, and tracking corrective action plans. 

 

9. Assists Compliance Officer in developing, producing, and conducting, regulatory reporting, risk assessment, workplans, readiness reviews, and the compliance program. 

 

10. Completes program integrity reporting.

 

11. Maintains confidentiality of client data.

 

12. Performs other related duties as assigned or requested.

 

Associate degree in business, health information processing or related field

Bachelor’s degree in business, health information management or related area 

One (1) to two (2) years of experience in the health-care setting

At least three (3) years of experience in health-care compliance or health-care

operations in a managed care environment

 

Working knowledge of Microsoft Office (Word, Excel, Outlook) 

Keyboarding proficiency

Excellent human relation and oral/written communication

Excellent organizational and prioritization abilities

Independent and creative thinker

Familiarity with compliance program requirements.

[This job requires the ability to perform the essential functions contained in the description. These include, but are not limited to, the following requirements. Reasonable accommodations may be made for otherwise qualified applicants unable to fulfill one or more of these requirements]:

 

Ability to enter and access information from a computer

Ability to access all areas of the UPHP offices

Occasionally lifts supplies/equipment

Occasional prolonged standing

Manual dexterity 

Works in office conditions, but occasional travel may be required

Exposure to situations requiring exceptional interpersonal skills or periods of intense concentration

Subject to many interruptions

Occasionally subjected to irregular hours