Dental Compliance Officer - Dental Services - Full Time - Days - Paramount
Toledo, OH
About the Job
Paramount Dental offers insurance products in Indiana, Kentucky and Ohio and pays claims in all 50 states. This Ohio- and Indiana-based company has been specializing in providing dental benefits to individuals since 1988.
Paramount Dental offers dental and vision plans to businesses of all sizes, participates in the Marketplace Exchange and serves thousands of Medicare members through partnerships with health plans throughout the United States. The company, originally founded by dentists, focuses on providing its clients with products that work to improve their overall health.
As a part of ProMedica, Paramount Dental is driven by ProMedica’s mission to improve your health and well-being. ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. Paramount Dental strives to provide an exceptional experience to every member.
REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES
Reports directly to the President, Health Resources, Inc.
POSITION SUMMARY
This position is responsible for assessing potential risks and directing, developing, and coordinating programs, policies, and procedures to ensure HRI’s compliance with federal, state, and local laws and regulatory requirements.
ACCOUNTABILITIES
- Manage the day-to-day operation of the HRI Compliance and Delegation Oversight Program.
- Identify potential areas of non-compliance, FWA issues, areas of potential risk, potential strategic advancements, and regulatory changes, and develop and implement corresponding action plans including but not limited to reporting any areas of excessive risk directly to the Board of Directors.
- Coordinate responses to government investigations and other inquiries or demands.
- Identify, investigate, and provide necessary reporting of violations/potential violations of rules, regulations, policies, procedures, and standards of conduct to leadership and/or regulatory agencies
- Monitor proposed federal and state regulatory and policy changes and identify potential risks to the organization. Represent HRI with various state and federal trade organizations.
- Research and provide guidance on federal and state health care program statutes, regulations, rules, and guidance regarding reimbursement, conditions of payments, new offerings, coverage, and other material requirements.
- Research and prepare responses to complaints (provider and/or member) filed with the state Departments of Insurance, attorney generals’ offices, Health and Human Services, and other state and federal administrative entities; identify trends/findings with significant policy/operational impact and address same.
- Proactively assess risks and execute the Compliance Plan, resulting in timely deliverables, and resolving and communicating issues/problems.
- Lead HRI's response to privacy and confidentiality concerns, authorization requirements, and informational notices and materials reflecting appropriate regulatory practices.
- Develop department-specific compliance training and education, as needed.
- Respond to Health Plan Partner Sponsor inquiries as needed.
- Chair the Health Resources, Inc. Compliance Committee and participate in various operational committees to ensure risk mitigation.
- Manage Company Compliance calendar ensuring all regulatory timelines are met.
- Manage Company Plan Filings process and monitor utilization of only filed products.
- Work in conjunction with the Legal and Compliance departments to assist with corporate regulatory requirements.
- Develop, initiate, maintain, enforce, and revise departmental policies and procedures; maintain all corporate policies.
- Additional duties as assigned.
REQUIRED QUALIFICATIONS
Education : Bachelor’s Degree in Business Administration, Law, or a related field
Skills:
- Related supervisory/managerial experience and the ability to establish a structure of communication and teamwork.
- Experience with Federally-Facilitated Health Insurance Marketplace regulations, privacy, and security rules established under the Health Insurance Portability and Accountability Act (HIPAA), and state laws and regulations concerning insurance and third-party administrators.
- Demonstrated technical knowledge of dental insurance, and government programs compliance/regulatory matters.
- Excellent verbal and written communication skills including the ability to communicate complex regulatory guidelines to all levels of the organization.
- Ability to plan, coordinate, and organize multiple priorities with minimal supervision.
- Proficient in using Microsoft Office programs, particularly Excel, Word, and PowerPoint.
Years of Experience : Minimum of eight years of legal or compliance experience and state or federal regulatory or managed care compliance experience.
License : N/A
Certification : N/A
PREFERRED QUALIFICATIONS
Education : Juris Doctor degree and a license to practice law in the relevant jurisdiction.
Skills : N/A
Years of Experience : Minimum of ten years of legal or compliance experience and state or federal regulatory or managed care compliance experience.
License : N/A
Certification : N/A
WORKING CONDITIONS
Personal Protective Equipment: N/A
Physical Demands: Must be able to move between offices and workstations and occasionally lift lightweight materials.
Travel: This position may be required to travel occasionally between Evansville, Indiana and Toledo, Ohio.
The above list of accountabilities is intended to describe the general nature and level of work performed by the incumbent; it should not be considered exhaustive.
ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org
Equal Opportunity Employer/Drug-Free Workplace
