UPMC is at the momment seeking for Compliance Editor on Tue, 03 Dec 2013 17:39:04 GMT. Board of Directors, Attorney General, Better Business... compliance letters to the Department of Health, Attorney General letters, Better Business bureau complaint...
Compliance Editor
Location: Pittsburgh Pennsylvania
Description: UPMC is at the momment seeking for Compliance Editor right now, this vacancy will be placed in Pennsylvania. Further informations about this vacancy opportunity kindly see the descriptions. UPMC Health Plan is hiring a full-time Compliance Editor to help support the Quality Improvement Department for its downtown Pittsburgh location.The hours for this position are Monday through Friday, standard daylight hours, or as needed.
The Compliance Editor will decrease plan exposure to bad faith or breach of contract law suits, regulatory sanctions, employer-group penalties and adverse media by effectively evaluating and ensuring accurate responses to complaints, grievances and appeals region-wide. The Editor will also ensure compliance with federal/state/contractual laws/regulations, ! plan policy and legal principles.
Responsibilities
- Review and assist in writing when appropriate response letters to members, providers, and regulatory or other agencies for complaints, appeals, and/or grievances, or other correspondence to that are directed to the President and CEO, Executive Staff, Board of Directors, Attorney General, Better Business Bureau, Congressional and Legislative Offices, News Media, Physicians' Ombudsman, Department of Labor, Corporate Law, the Insurance Bureau, etc.
- Maintain thorough knowledge of policies, procedures, guidelines, regulations, timeframes, and/or appeals processes dictated by Federal and State legislation/regulations, (i.e. Act 68, Act 62. ERISA, HIPAA, PPACA, Medicare Advantage, Medicare Part D as well as UPMC policies and procedures and benefits for all lines of business and assure that resolutions and written responses are compliant.
- Ensure plan consistency in organizational responses and represent senior managers by developing written respons! es to inquiries or complaints directed to Health Plan and regional senior leaders
- Reduce potential plan liability by ensuring compliance with explicit and implicit contractual obligations and federal/state government laws/regulations
- Review and approve communications to regulatory agencies. This will include evaluation of the PA Insurance Department complaint responses, fair hearing compliance letters to the Department of Health, Attorney General letters, Better Business bureau complaint responses, Centers for Medicare and Medicaid Services (CTM ¿ Complaints tracking Module) responses, Federal Employee Health Benefit (FEHB) appeals to Office of Personnel Management (OPM); and other communications as needed.
- Evaluate trend analysis. Analyze and report statistics in order to establish trends. Evaluate and take action to positively impact these trends.
- This will include meeting with other departments to help influence their work-flows in or! der to decrease complaints and collaborate on development of company-wi! de solution
Basic Qualifications
- Paralegal with degree in paralegal studies preferred
- Two (2) to Three (3) years of Paralegal experience required and medical terminology experience preferred.
- Excellent written and verbal communication skills, exceptional knowledge of English writing/grammar along with ability to present before large and small groups essential.
- Must be able to write complex letters in a concise, cogent manner while establishing patterns and addressing issues in the way resolutions and other information is communicated.
- Strong analytical, organizational, problem resolution, verbal and written communication skills.
- High regard for protecting confidentiality of corporate information.
- In Depth knowledge of federal and state regulations pertaining to adverse benefit determinations, grievances and appeals and provision of care/services preferred
- Basic knowledge of legal con! cepts; e.g., contract law, malpractice
- Ability to assimilate and apply complex and diverse state/federal regulations, accreditation requirements, and similar material
- Excellent writing skills; demonstrated ability to summarize complex and sensitive information, and write reports/memos/letters in a clear, concise, non-judgmental, non-threatening and effective manner
- Excellent judgment, analytical and problem-solving skills; demonstrated ability to interpret complex medical, contractual or legal material, identify important issues, assess completeness or adequacy of information, make independent decisions under a frame work of general policy and develop effective recommendations
Licensure/Certifications
- Paralegal certification or degree
Salary Range:
17.68
23.22
29.36
UPMC is an equal opportunity employer.
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If you were eligible to this vacancy, please email! us your resume, with salary requirements and a resume to UPMC.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Tue, 03 Dec 2013 17:39:04 GMT
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