Compliance Specialist - JHP

Thomas Jefferson University & Jefferson Health
paid time off
United States, Pennsylvania, Philadelphia
Jun 05, 2025
Job Details This position is responsible for support of the administration and oversight of Health Partners Plans' (HPP) Compliance Program. The Compliance Specialist will support the Compliance management team by ensuring ongoing compliance with contractual and regulatory obligations and State and Federal requirements related to health insurance and managed care. In close collaboration with all business units, this position will provide support throughout HPP in the organization's efforts to achieve key objectives, maintain and improve compliance. The Compliance Specialist will play an integral role in researching and tracking regulatory issues and maintaining full regulatory compliance. This role is responsible for supporting a diverse range of compliance-related responsibilities associated with HPP's Medicare Advantage/Prescription Drug Program, Pennsylvania Medicaid, Pennsylvania CHIP lines of business. Job Description Receive, coordinate follow-up and respond to all requests for information and/or clarification received from regulatory entities or internal business units/departments. Once documentation is ready to submit to a regulatory entity, the Compliance Specialist will review prior to submission Assist management in reviewing, clarifying and disseminating pending and newly enacted regulations, sub-regulatory guidance and state contractual revisions to appropriate HPP staff Serve as a point of contact for all internal departments for management of CMS/ DHS communications including, but no limited to: HPMS issued guidance, Medical Assistance Bulletins, Managed Care Operations Memos, System Notices, relevant regulatory and sub-regulatory guidance, and HealthChoices/ CHIP contractual revisions Assist in workgroups for implementation of Medicare, HealthChoices, and CHIP requirements Assist with development of internal policies and procedures Ensure the timely and accurate review, routing and tracking of regulatory submissions Support the Compliance department with data reporting needs Submit marketing materials to CMS for regulatory review and approval Provide support for both internal and external audits when necessary Review audit results when appropriate in order to enhance Compliance monitoring activities Provide support for Compliance monitoring activities when necessary Assist in the investigation of both actual and suspected compliance risks Maintain accurate and timely reporting/project mechanisms that afford management with easily accessible information regarding the status of compliance issues Develop "job aids" conveying compliance requirements for use by the Compliance department Develop and maintain collaborative relationships with internal and external customers Education: Bachelor's Degree Preferred Experience: 3-5 years firm managed care operations or compliance experience required. Preference to demonstrated experience with Compliance program management and support for a managed care organization Skills/Abilities: Strong written and verbal communication skills working with various levels within and outside of the organization Knowledge of CMS/DHS compliance standards and regulations Strong problem-solving skills. Ability to identify issues in health plan or delegated entity operations, administrative activities, and other areas which could result in non- compliance with CMS or health plan requirements Ability to work independently and collaboratively with internal departments Proficient in Microsoft Office products (e.g. Microsoft Word, Excel, Outlook E-mail, Power Point, etc.) Ability to participate as a team player to meet all work requests/deadlines within standards to contribute to the organization's overall performance Ability to provide continual updates to management on all issues, bringing those with potential impact/ risk to the attention of management immediately Ability to accept and manage multiple priority issues/assignments and work autonomously without continual intervention by management to complete tasks Work Shift Workday Day (United States of America) Worker Sub Type Regular Primary Location Address 1101 Market, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years. Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits At Jefferson, we offer a comprehensive total rewards package designed to support the health and well-being of our colleagues and their families. It includes a wide range of benefits including competitive pay, health and retirement benefits, life and disability insurance, paid time off, educational benefits, financial and mental health resources and much more. Our diverse benefits offerings ensure you have the coverage and access to services you need to thrive both personally and professionally.