CASY-MSCCN Jobs

Duties and Responsibilities:

Business lead for external and internal regulatory reporting, surveys, audits, and investigations impacting dental operations

In partnership with the business and key partners, continuously drive a strong culture of compliance

Directs, investigates, and resolves regulatory compliance concerns

Ensures compliance with existing and new rules, regulations, and revisions, as set forth by federal and state law

Identifies improvement opportunities to ensure compliance with company standards, policies and procedures, as well as federal, state, and local regulations.

Develops and oversees monitoring activities, using appropriate tools and monitoring techniques, to ensure compliance

Acts as lead in identifying and prioritizing areas of risk and opportunity, while providing recommendations that influence business solutions

Prepares and disseminates reports on audit and monitoring findings, along with corrective and preventative action recommendations

Provides guidance to the business to ensure documents, projects, processes, or initiatives stay in sync with regulatory requirements and enterprise policy

Maintains up to date knowledge of federal and state requirements and practices to perform tasks and duties

Fosters and maintains good working relationships with leadership and other stakeholders

Additional duties as necessary

Minimum Qualifications:

Bachelors degree from an accredited institution with 4 or more years of related experience, or 10 or more years of related experience in lieu of a degree. Relevant experience includes compliance, risk, legal or audit within the health insurance industry

Demonstrated experience working in a highly regulated environment

Proven ability to apply advanced knowledge of regulatory compliance to consult and provide insight and guidance

Experience in conducting delegated vendor oversight, monitoring compliance activities, and developing effective corrective action plans.

Expert (oral and written) communication to provide effective challenge to compliance risk matters, document work performed in a clear/concise manner, as well as prepare reports and presentations for management

Intermediate to advanced knowledge of Microsoft Office tools including Word, Excel, and PowerPoint

Preferred Qualifications:

Advanced knowledge of compliance laws, regulations, and regulatory expectations in dental utilization management, appeals and claims

Strong organizational skills

Ability to foster a culture of compliance

Demonstrated professionalism and leadership skills along with the ability to develop, direct and support a team

Compliance & Regulatory Responsibilities: Noted above.

License/Certification: N/A

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, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.