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Professional - Non-Clinical
Compliance Specialist - The Health Plan
Houston, TX, US
We are searching for a Compliance Specialist -- someone who works well in a fast-paced setting. In this position, you will plan and manage or assist on assigned audits, reviews, investigations, and projects to ensure compliance with state and federal rules, regulations and statutes. To further assist in the management of the Corporate Compliance Program by monitoring the healthcare regulatory environment, updating leadership on regulatory changes related to corporate compliance, maintaining Compliance Program documentation and databases, and assisting with compliance training and education
Think you’ve got what it takes
Job Duties & Responsibilities
• Audit/Review/Investigation/Project Test work and Project Reporting, Work paper Preparation. Schedules entrance or exit conference as directed by leadership. Attends all entrance and/or exit conferences as directed by leadership. Performs audit test work in accordance with documented audit program steps.
• Monitors Regulatory Environment. Reviews and interprets information related to compliance and the regulatory healthcare environment by monitoring appropriate federal, state, and healthcare industry websites, publications, and journals. Notifies compliance leadership and/or pertinent personnel of changes or areas of concern.
• Monitors Documentation and Retention. Maintains database of reported compliance issues on an on-going basis and assists in the design of reports to ensure appropriate monitoring of unresolved compliance issues. Monitors the Corporate Compliance website on the Intranet and updates with appropriate information.
• Uses Appropriate Communication/Interaction Skills. Demonstrates initiative by suggesting new reviews/projects or expansion of existing reviews/projects. Collaborates with the compliance team, Audit Services, Business Services, Office of the General Counsel, Risk Management and other project partners to achieve desired outcomes.
• Assists with Compliance Awareness, training activities, and the evaluation of the effectiveness of the Corporate Compliance Program.
• Achieves and maintains professional certifications. Reads current literature in professional field regularly and applies where appropriate. Participates actively in appropriate committees as assigned or voluntarily as observed by leadership.
Skills & Requirements
• High School Diploma or GED
• 1 year in a regulatory environment including specific experience in project management and audit type work such as planning, executing reviews or investigations.
• An associate or bachelor's degree may substitute for years of experience.
Please Note: This is a hybrid position. Does not support fully remote work
About Texas Children’s
Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
