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Date Last Verified
Years of Experience
ProfileRegulatory Compliance Administrator The candidate provides support to and administration of the compliance program. Will responsible for updating, maintaining and overseeing the filing of all required regulatory documents with Federal and State regulators and will assist the compliance officer with updating, enhancing and administering all aspects of the Compliance Program. Will prepare and review regulatory form filing and other required documents, reports, communications, policies and provide assistance with development and review of contracts. Demonstrates commitment and behavior aligned with the philosophy, mission, values and vision of firm. Assures that NHP/NHIC/NHAS 's operations, policies and procedures and benefit interpretations are in compliance with all applicable regulations and statutes. Monitors legislative developments pertaining to health care/managed care; summarizes and distributes updates regarding relevant legislative topics to NHP/NHIC/NHAS departments and agents; ensures that all associates understand the applicable regulatory and legal requirements and their responsibility to adhere to them. Continually reviews NHP/NHIC/NHAS 's policies and procedures, benefit interpretations, etc. and undertakes new initiatives to ensure compliance with state, federal and Centers for Medicare and Medicaid Services (CMS) program requirements/legislation. Reviews benefit and administration questions from other NHP/NHIC/NHAS departments ( i.e., claims, health management, etc.) in comparison with state, federal and HCFA regulations. Develops policies and procedures to ensure compliance. Recommends modifications and updates to plan and provider documents and contracts to comply with regulatory and statutory provisions; reviews and approves documents and contracts in regard to compliance issues; develops and maintains procedures for review, approval of filing and distribution of plan and provider documents and contracts. Maintains central form, regulatory and legal documentation files; assists the compliance officer in the coordination of OCI market conduct examinations and CMS regulatory audits. Oversees the updates and development of employer group contracts and Evidence of Coverage (EOC) documents to ensure regulatory compliance. Prepares regulatory filings; responds to regulation concerns and requests. Reports on the progress of the regulatory compliance area, providing reports, analysis and/or comparative data. Responsible for the identification, implementation, and maintenance of NHP/NHIC/NHAS information privacy policies and procedures in coordination with the compliance officer and security officer. Maintain organization governance documents related to bylaws and operating agreements for all Boards of Directors governing and its associated organizations. Subpoena response data gathering and coordination, including assurance of appropriate authorizations and/or court orders. Develop and oversee an accessible and useful centralized system process for affiliated entity governance documents and authority matrices. Responsible for the management and retention of key business documents in accordance with document retention guidelines as well as record retention policy. Review vendor contracts and track the designation of First Tier, Downstream or Related Entity or Offshore Subcontractor status, and report such statuses to the Centers for Medicare and Medicaid Services, as necessary. Responsible for reviewing materials intended for members, agents and/or providers to ensure materials meet all requirements outlined by the State and Federal regulations. Performs other duties as assigned. Associate degree required. Paralegal training and certification preferred. Bachelorâ€™s degree preferred. Must have 1+ year related work experience in an insurance company. Must have 1+ year of experience in a paralegal or compliance driven role. Should have experience working with state and federal insurance regulatory agencies. Should have experience working within a legal or compliance related department preferred. Must have experience establishing relationships with insurance personnel and examiners preferred. Exposure/experience with underwriting, claims and/or contracts preferred.
1570 Midway Place
Menasha, WI 54952