Regional Compliance Coordinator

POSITION SUMMARY

The Regional Compliance Coordinator supports GT’s Compliance and Quality Initiatives. This role also serves as the Compliance Liaison and the subject matter expert for the assigned region's internal and external compliance functions.

RESPONSIBILITIES AND DUTIES

Provides support to the Compliance Department and shared Quality Assurance Initiatives, which include the following:

• Collaborates cross-functionally with GT departments on compliance and QA-related issues.
• Maintains current knowledge of contract and regulatory requirements. Researches and develops resources to facilitate GT’s compliance with contract requirements, regulatory requirements, and GT policies and procedures.
• Conducts investigations for internal and external compliance issues, including reports of potential privacy, fraud, complaints/grievances, policy, code of conduct, and contract violations. Escalates issues as needed. Facilitates timely reporting of contract requirements related to regional compliance functions.
• Assists with CARF credentialing reviews, readiness reviews, external audits/assessments, corrective measures, and business implementation projects.
• Maintains and updates compliance files and associated documents per the department’s procedures.
• Maintains and updates compliance department policies and procedures, as needed.
• Tracks and trends data, analysis, and reports for compliance functions, as requested.
• Assists with the development and implementation of annual auditing and monitoring plans. Performs internal audits and monitoring of controls according to the plan.
• Monitors the Compliance FWA hotline as assigned.
• Performs monthly database exclusion screenings as assigned.
• Assists the Legal and Contracts department with projects as needed.
• Attends, prepares required documentation and participates in team meetings, GT agency meetings, GT Week, assigned training(s), and committee meetings (Compliance Committee, Quality Committee, CARF Committee, Fraud prevention workgroup, etc.)
• Performs other duties as assigned, including serving as a backup to other members of the Compliance team
• Completes job duties and assigned tasks within required time frames
• Maintains strict adherence to GT policies and procedures, Code of Conduct, confidentiality, and other applicable legal and contract requirements

Operations- Regional Duties

• Supports regional teams with maintaining compliance with their contracts and regulatory requirements.
• Serves as a subject matter expert, assisting with questions, disseminating information, and contract/regulatory updates to Directors, Ops Managers, and Team Leaders.
• Assists with process improvement projects to facilitate compliance and reduce risk.
• Review regional documents, policies, procedures, and processes for compliance as requested.
• Serves as the compliance liaison for the assigned region. Attends provider meetings (compliance-related) and facilitates external audits, compliance issue resolution, and corrective measures.
• Supports new business implementation within the region
• Develops compliance training and resources; Assists with staff training as needed.
• Attends Team meetings monthly to facilitate communication of requirements and address barriers to meeting requirements.

EDUCATION & CERTIFICATIONS

• High School Diploma/GED required
• Bachelor’s Degree preferred
• Compliance related certifications preferred

EXPERIENCE AND QUALIFICATIONS

• Requires 2 years of experience working with federally funded healthcare programs (Medicaid/Medicare), CMS Waivers, or HCBS programs. Experience with Financial Management Services and healthcare billing preferred.
• 2 years of compliance/quality-related experience preferred (i.e., Interpreting contracts and regulatory requirements, auditing & monitoring, performing investigations, corrective action plan implementation & monitoring, reporting, QA, HIPAA/privacy, etc.)
• Experience with Microsoft Office, Teams, Zoom, SharePoint, project planning and management, and other related software applications pertinent to the position.
• Ability to research and interpret contracts, regulatory requirements, provider manuals, agency policies, and procedures.
• Must be able to work in a faced paced environment while maintaining attention to detail.
• Excellent multi-tasking, critical thinking, problem-solving, and written/oral communication skills
• Ability to work as a team and independently. Ability to work with all levels of an organization, including representatives from state departments (OIG, HHS, DOL, etc.)
• Maintains and promotes high ethical standards and GT’s values.

WORK ENVIRONMENT

Work is performed in a typical office setting or a remote office setting in compliance with GT’s remote workforce policies and procedures.