Compliance Senior Resume Sample

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Jamal Huels
147 Cronin Lock,  New York, NY
+1 (555) 807 2541

Work Experience

Compliance Senior Specialist
05/2018 - PRESENT
Phoenix, AZ
  • Prepares complex data structures and arrays for internal audit compliance. Researches complex problems and errors for solution
  • Maintains metrics needed to comply with legislative and internal requirements. Prepares, analyzes, and distributes reports as appropriate
  • Prepare initial and ongoing due diligence reviews and reports
  • Review and analyze data for trends, potential actions, and training needs
  • Ensure adequate documentation is maintained in all phases of work
  • Support workgroup and committee activities and the preparation of reports on Risk Management and Compliance Program-related programs
  • Provide technical assistance and guidance to staff on BSA/AML and OFAC compliance matters as assigned
  • Stand 5-10% of workday
  • Sit 90 - 95% of workday
Compliance Senior Associate
11/2011 - 03/2018
Phoenix, AZ
  • Operate computer keyboard and other office equipment
  • Assisting with issue and deliverable tracking and material for periodic update meetings with Internal and External Auditors
  • Owning timely update of controls and narratives in our controls repository tool
  • Being the first line of contact for requests related to Express Scripts' three SSAE 16 SOC 1 Type II reports and providing timely client service to sales and account management and external SOC 1 report users
  • Other responsibilities such as performing preliminary controls testing where required to assess design effectiveness, assistance with follow-up and co-ordination with control owners, auditors and IT regulator compliance team
  • Knowledgeable with SOX/Financial Statements/Internal Audit
  • Advanced MS Office including Excel, SQL
  • Read, comprehend, and analyze governmental regulations required
  • Communicate and manage the timeliness of responses and maintain accurate tracking database of accounts, correspondence, actions, and outcomes required
SOX & Compliance Senior Professional
10/2008 - 06/2011
Philadelphia, PA
  • Interact on a professional basis with members of the medical staff, management, and ancillary departments required
  • Communication skills, both written and verbal required
  • Organizational skill (ability to multitask and prioritize) required
  • Work within stressful conditions and difficult situations required
  • Function independently and work effectively in a team environment required
  • Analytical skills to define problems, formulate logical solutions, and make recommendations required
  • Speak and present in both small and large groups required
  • Certified Professional Coder (CPC), Certified Coding Specialist-Physician Based (CCS-P), and/or current Physician Coding Specialist (PCS) certification required
  • Ensure Medicare rules and regulations are communicated timely and in a clear and concise manner to facilitate the business’ understanding of the rule or regulatory change


Antioch University McGregor
2003 - 2008
Bachelor's Degree in Management

Professional Skills

  • Superior skill and experience in oral and written communication skills and writing / editing experience and skills
  • Strong planning, organizing, and prioritizing skills
  • Strong planning/organizing/prioritizing skills
  • Strong computer skills/PC literacy; proficient in Microsoft Word and Excel
  • Collaborative team player and relationship builder with excellent interpersonal skills
  • Managing multiple relationships and collaborating with stakeholders across functional and technical skillsets throughout major transformation
  • Strong educational qualifications including Accounting work experience

How to write Compliance Senior Resume

Compliance Senior role is responsible for auditing, compliance, research, medicare, finance, training, database, marketing, security, trading.
To write great resume for compliance senior job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Compliance Senior Resume

The section contact information is important in your compliance senior resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Compliance Senior Resume

The section work experience is an essential part of your compliance senior resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous compliance senior responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular compliance senior position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Compliance Senior resume experience can include:

  • Maintain good working relationships with internal and external parties to ensure open lines of communications and timely responses to compliance questions
  • Experience dealing with regulators
  • Experience dealing with regulators
  • Good technical understanding, with the ability to translate from business speak to tech
  • Knowledge of NCQA and strong understanding of rules and regulations
  • Experience using Excel, Access, and SharePoint

Education on a Compliance Senior Resume

Make sure to make education a priority on your compliance senior resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your compliance senior experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Compliance Senior Resume

When listing skills on your compliance senior resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical compliance senior skills:

  • Strong demonstrated oral and written communication skills
  • Strong interpersonal skills, judgment, maturity and flexibility
  • Strong excel skills important
  • Excellent written and verbal communication skills across a variety of audiences
  • Strong written Communications: Exceptional verbal and written communication skills
  • Maintaining databases and records to demonstrate an effective process to identify key requirements

List of Typical Experience For a Compliance Senior Resume


Experience For Compliance Senior Specialist Resume

  • Executes testing and monitoring plans on a continuing basis while taking appropriate steps to improve the overall effectiveness of the Compliance Program
  • Displays project leadership and project team development. Delivers results that drive improved efficiency and effectiveness across Legal and Business teams
  • Coordinating review of legal and regulatory changes to support regulatory change management process
  • Balancing between business stakeholders and a central technology service organization
  • Conduct local Healthcare Compliance monitoring activities and support the business in designing and implementing improvement actions
  • Responsible for agenda development and conducting monthly Compliance Committee meetings, and supporting completion of all related action items
  • Continue developing and enhancing the local Healthcare Compliance Champion program with cross-functional staff members
  • Provide guidance to client-serving teams, including complex or non-routine questions, and liaise or coordinate appropriate responses or consultations

Experience For Compliance Senior Associate Resume

  • Review and analyze compliance learning reports and sanctions screening reports
  • Proficiency with MS Office Suite, in particular Excel; including the use of pivot tables, formulas and charting
  • Basic working knowledge of sanctions screening rules and regulations
  • Support Compliance program oversight by maintaining documentation of compliance issues and ensure updates are documented in a timely manner
  • Work collaboratively with others (and when appropriate influence colleagues in their decision making process) required; and
  • Lead compliance engagements surrounding various functions of community banks and other financial institutions
  • Ad-hoc financial projects, often working with Tax, Treasury and Global Controllership
  • Obtain and review import and export documentation ensuring compliant authentication of claims
  • Maintain compliant and user-friendly recordkeeping to support all claims and filings

Experience For In-use Emission Compliance Senior Engineer Resume

  • Report results for each round of claims/filings; maintain historical results Identify and implement additional duty saving programs
  • Draft or update policies, procedures, training and communications, primarily related to EY’s anti-corruption and economic sanctions compliance program
  • Identify risks in the RM function or process by comparing facts and circumstances to current EY policies
  • Maintain and expand knowledge within area of expertise, communicate new developments and resulting impact to relevant stakeholders
  • Develop an understanding of key independence rules and EY policies
  • Interact with personnel at all levels, including executive leadership
  • Work collaboratively with State Filing Language Team to initiate the process to move filed and approved language into production
  • Represent product filings, compliance issues impacting applicable product and enhancement products
  • Adapt and thrive in a flexible, fast-paced environment, while maintaining a positive, solution oriented approach

Experience For SOX & Compliance Senior Professional Resume

  • New and Changing Legislation
  • Develops on-screen tool manual directions for users of the “Benefit Sculpting Tool/Plan Portal” to comply
  • Advisor for Business teams when implementing new policies and procedures
  • Supports Business teams when implementing new policies and procedures
  • Collaborates with other departments to support compliance issues to appropriate existing channels for investigation and resolution

Experience For Trade & Compliance Senior Specialist Resume

  • Helps ensure that compliance issues/concerns within the organization are being appropriately evaluated, investigated and escalated as appropriate
  • Collaborates with the credentialing department on professional license renewals for providers
  • Participates in implementation meetings to pro-actively determine business license needs and initiate licensing
  • Remains current on new or updated legislation, regulations or other external/internal directives impacting the business
  • Analyze and manipulate complex producer data using Access/Excel
  • Liaise with external vendor/auditor for testing of BCPs applicable to areas that handle swap activities
  • Collaborate with the business to develop process changes to ensure compliance with rule or regulatory changes
  • Provide subject matter expertise in response to day-to-day business issues
  • Serve as a point of contact for employees to seek clarification on regulations or to report any note compliance issues or irregularities

Experience For Energy Operations Compliance Senior Project Manager Resume

  • Assist in the management of Corrective Action Plans (CAPs) for Medicare related issues
  • Support business units by collaboratively facilitating the development of processes and procedures to ensure regulatory compliance, including participation in regular operational team meetings, business process improvement efforts, and compliance improvement initiatives
  • Strong knowledge of Medicare Advantage regulations required,
  • Manages relationships with partners both internal and external; performs or assists in coordination of training related program; and
  • Subject matter expertise in Pre-service Organization Determination guidance and processes required
  • Subject matter expertise in Medicare Advantage Appeals and Grievances guidance and processes required
  • Actively promote and help drive BB&T’s Culture of Compliance and the Compliance Risk Framework
  • Monitor trade compliance operational performance through metrics and KPI’s
  • Oversees the day-to-day operations of organization’s Compliance programs. Manages programs, policies, and practices to monitor and ensure compliance with the laws, regulations and rules of federal, state, and self-regulatory organizations

Experience For Compliance Senior Supervisor Resume

  • Ensures department’s record keeping systems are updated and maintained appropriately
  • Develop, write, roll-out and support the implementation of FATCA, QI, CRS and US Withholding Tax Compliance policies in line with the Internal Control Framework Binding Principles and develop related (monitoring) tools. This includes drafting of guidance materials, managing the waiver process and acting as an escalation point
  • Participate in bank’s projects in order to advise and assist the business to identify compliance risks, implement risk mitigating measures, include clear standards, procedures and guidelines, to prevent, mitigate or minimize (important) compliance risks and to detect, report and respond to compliance violations
  • Capable of multitasking in a dynamic, performance-driven culture
  • Monitor and manage group e-mail box, researching and responding to client & consumer escalations; Claims’ requests; validations of beneficiary records; and general questions

Experience For UW & Product Compliance Senior Specialist Resume

  • Identify and remove from the website products that violate our Restricted Products policies and proactively satisfy Amazon’s regulatory obligations for these products
  • Provide the GM and other local Management Team members with strategic compliance support and advice on such matters as new projects/initiatives, launch planning and activities, Tone at the Top initiatives, and annual goals and business plans
  • Provide leadership, advice, guidance, direction and support to office and field based staff and applicable third parties on interpretation and implementation of the local Code of Practice and Amgen healthcare compliance policies, procedures and practices
  • Champion ethical/compliance tone throughout the organization
  • Draft, revise and maintain all local healthcare compliance SOPs and Policies
  • Participate in and monitor changes at local Trade Association/ local Code Association & in national legislation. Forward relevant information to local teams and regional groups with recommended changes to compliance framework or strategy
  • Participate in compliance initiatives/projects/expert review team for Regional Healthcare Compliance and support the local implementation of Corporate and Regional Compliance Programs
  • Typically has 5-7 years of related experience

Experience For Compliance Senior Mgr Resume

  • Working with local law, implement all requirements of the Global Distributor program such conducting due diligence and live training
  • Review, translate (if applicable), provide comments and implement Regional Healthcare Compliance procedures and training
  • Support periodic Corporate Audits and Design Reviews
  • Serve as the country Data Privacy Officer
  • Provide subject matter expertise in response to day-to-day business issues and questions
  • Manages the Corrective Action Plans (CAPs) for Part D related issues
  • Intimate knowledge of Part D regulations including Formulary Administration (FA), Coverage Determinations Appeals & Grievances (CDAG), EGWP and other Part D operations/performance areas
  • Establish and supervise accounting control procedures

Experience For BSA Compliance Senior Specialist Resume

  • Ensure accurate and adequate recording and analysis of income and expenditure
  • Establish direct contact with the external consultants of the company
  • Preparation of the financial audit and coordination of the audit process
  • Preparation of periodic reports based on budget analysis
  • The intercompany royalty calculations (Brand, IP Contributions, Sequel charges) and payments (Operating Fees and Parent Company Share) between EMEA, UK and US entities
  • Quarterly financial reporting and Disney controls reporting (including Sarbanes-Oxley)

List of Typical Skills For a Compliance Senior Resume


Skills For Compliance Senior Specialist Resume

  • Strong planning/organizing/project management/prioritizing skills
  • Strong oversight and monitoring skills
  • Aptitude & desire to learn new research methods and skills on a continuing basis
  • Health care compliance/regulatory review experience or other relevant experience
  • Compliance experience with proven ability to act independently and decisively, with minimal supervision in a fast paced and dynamic environment
  • Strong interpersonal and collaborative skill and ability
  • Strong experience of data analysis
  • Experience in cost estimating, accounting, auditing, finance, procurement, engineering, or other related field
  • Experience in creating reports and working with regulators

Skills For Compliance Senior Associate Resume

  • Creative, innovative, “out of the box” thinker who is passionate for devising and delivering impactful and effective communications
  • Experience in a similar compliance role or trading environment
  • Build effective working relationships and thrive in a diversified and multicultural work environment
  • Corporate compliance experience, particularly in addressing corruption and economic sanctions risks
  • Experience managing major projects
  • Experience working with the COSO Internal Control Framework
  • Experience with SharePoint managing workflows and data

Skills For In-use Emission Compliance Senior Engineer Resume

  • Healthcare regulatory or marketing compliance experience
  • Experience supporting regulatory authority inspections of pre-clinical, clinical research, and/or pharmacovigilance activities
  • Manage multiple, sometimes competing, priorities
  • Banking Compliance experience required
  • Acquire and demonstrate intermediate knowledge of policies, procedures and regulatory requirements pertaining to risk management and compliance
  • Experience working in Amber Road’s Trade Automation platform
  • Manage competing priorities and provide high level of responsiveness across multiple stakeholders
  • Manage multiple, sometimes competing priorities
  • Prior success with using SAP security

Skills For SOX & Compliance Senior Professional Resume

  • Prioritize and manage multiple projects simultaneously in a fast-paced, dynamically changing work environment
  • Develop and improve systems and processes to enable effective communication with all levels of employees
  • Experience with the NERC CIP Standards
  • Experience with NERC O&P Standards
  • Experience in transmission operations or maintenance
  • Highly motivated with a strong willingness to take ownership of assigned work
  • Experience in regulation and payer guidelines in behavioral health, physical therapy, speech therapy, occupational therapy or genetics based on department

Skills For Trade & Compliance Senior Specialist Resume

  • Experience in regulation and payer guidelines in anatomical and clinical pathology
  • Experience with Medicare Claims is required
  • Related communications experience
  • Strong attention to detail and clarity of thought and expression
  • Highly collaborative individual with the ability to influence others and build strong personal relationships
  • Operate both independently and as part of a larger in-house compliance group

Skills For Energy Operations Compliance Senior Project Manager Resume

  • One of Advisory Registrations Regulations experience is Required
  • Successful experience in insurance or healthcare industry
  • Developing, preparing, presenting and maintaining project plans
  • Reviewing, analyzing and evaluating financial data as well as preparing budgets and financial forecasts
  • Conducting research and developing and documenting business cases
  • Resolving multi-faceted problems by continuously applying significant independent judgment and by collaborating with others

Skills For Compliance Senior Supervisor Resume

  • Refining and implementing project management methodologies, tools and practices
  • Selecting and managing project teams
  • Developing business modeling presentations
  • Obtaining and retaining customers
  • Influencing others through a small team of direct reports, through work on projects and in teams, or through leading portions of larger projects
  • Willing to travel to various suppliers to interface with Quality Engineers, Technicians, and local personnel
  • Reporting and data visualization tools (e.g. Microsoft SSRS, Tableau, Qlikview)
  • Using specific systems and related technological tools associated with assigned functional areas
  • Applying application development and project life cycle methodologies and standards

Skills For UW & Product Compliance Senior Specialist Resume

  • Performing project risk assessments
  • Developing service level agreements for new systems
  • Negotiating with customers and vendors
  • Understanding of audit/compliance program design
  • Understanding Information security controls and Information Security Management Systems (ISMS) standards such as ISO27001/2, CobIT, CRISC etc
  • Responsible for the tracking, administration and reporting associated with the annual All Employee Medicare Compliance training
  • Responsible for tracking all healthcare compliance assigned training and managing follow-up reminders
  • Provide problem resolution/troubleshooting with regulators, customers, and internal matrix partners regarding regulatory issues, concerns or complaints
  • Comfortable identifying regulatory, legal gaps with matrix partners and facilitating the implementation of measures to remediate those gaps

Skills For Compliance Senior Mgr Resume

  • Ensures compliance with state and federal laws and regulations for new, existing and expanding business
  • Manages the overall process of license application and renewal including investigation of regulations for new or expanding business
  • Maintains record keeping in accordance with business and professional licensing
  • Light project management work in the form of documenting and following up on Corrective Action Plans to ensure business implements required solutions
  • Track record of meeting schedule, budget and quality goals when leading projects
  • Develop training materials and deliver frequent healthcare compliance and anti-corruption trainings, including new hire orientation
  • Represent Privacy and Ethics issues on the Corporate Outsourcing Risk Committee

Skills For BSA Compliance Senior Specialist Resume

  • Respond to inquiries from internal matrix partners and external regulators regarding state-specific requirements and miscellaneous regulatory/compliance issues
  • Confident at delivering tough messages to firm leaders
  • Collaborates with various business stakeholders to understand and summarize compliance issues for external reporting to regulatory agencies (CMS)
  • Adapt and thrive in a flexible, fast-past environment, while maintaining a positive, solution oriented approach
  • Determine needs and conduct training to support business partners on the development and maintenance of written policies and procedures and related workflows
  • 4 Common Reporting Standard

List of Typical Responsibilities For a Compliance Senior Resume


Responsibilities For Compliance Senior Specialist Resume

  • Providing reporting to management and risk committees
  • Assist in identifying and closing any gaps identified by applicable testing and audit procedures
  • Coordinate with Audit Services regarding internal audits and annual testing requirements as outlined in the regulations
  • Conduct Firm Element and Registered Representative Training
  • Coordinate with London and Singapore Risk & Compliance to ensure standardized, global approach is being taken when applicable
  • Assist in developing the annual CCO report, annual CEOC report, and other presentations as necessary
  • Retrieve and synthesize large amounts of data from multiple sources
  • Process and prepare all appropriate data and documentation for submission to U.S. Customs

Responsibilities For Compliance Senior Associate Resume

  • Track all claims and filings, associated recoveries/payments, and liquidations
  • Create schedules and associated project plans to balance work flow throughout the year
  • Develop and maintain procedures related to duty drawback and reconciliation
  • Proficient in MS Excel & MS Access
  • Work with minimal supervision in a highly cross-functional environment

Responsibilities For In-use Emission Compliance Senior Engineer Resume

  • Supporting process design and implementation of an enhanced regulatory change management process across Freddie Mac’s three lines of defense to maintain an effective compliance risk management program
  • Coordinating with other risk oversight areas to prevent gaps in Freddie Mac’s policy and standard framework designed to mitigate risk associated with legal and regulatory requirements
  • Research laws and regulations, and address issues, around the areas of anti-corruption and economic sanctions risks
  • Manage content for the Anti-corruption and Economic Sanctions intranet and social media sites
  • Apply judgment to consultations and compliance reviews
  • Conducts preliminary investigation for complex project requests. Reviews requirements, specifications and testing. Ensures training plans are aligned with organizational priorities, business plans and objectives
  • Provides a proactive interface for project stakeholders and senior management teams to ensure business requirements are completely and accurately defined. Ensures business applications are delivered

Responsibilities For SOX & Compliance Senior Professional Resume

  • Refines and implements project management methodologies, tools and practices to provide continuous process improvement
  • Selects and manages project teams. Manages such teams throughout the project lifecycle including planning, assigning, scheduling, monitoring and reviewing project activities, as well as evaluating individual performance upon project completion
  • Conducts interviews, compiles and analyzes responses, and creates business cases for projects
  • Participates in root cause analysis in order to recommend appropriate actions to improve productivity and efficiency
  • Develops, prepares, presents and maintains project plans including staffing requirements, cost estimates, detailed budgets and work breakdown structures and schedules

Responsibilities For Trade & Compliance Senior Specialist Resume

  • Performs project risk assessments by identifying key risk factors, providing effective mitigation strategies and assigning contingency action plans to both schedules and budgets
  • Applies established project methodologies to manage projects: uses change control templates and processes, manages time and recording activities using defined scheduling tools, monitors budgets, and coordinates resource acquisition and utilization
  • Collaborates with other departments to direct compliance issues to appropriate existing channels for investigation and resolution
  • Serves as the liaison between internal customers and external suppliers. Communicates regularly with project stakeholders
  • Delivers systems on appropriate platforms in compliance with established technology standards. Monitors testing and executes quality assurance checks to ensure the system meets information technology acceptance criteria prior to implementation
  • Performs project evaluations and participates in post-project quality monitoring
  • Creates and/or co-owns “user stories” for IT automation of the compliance benefit mandates, working with the business teams and other experts within Legal. Participates in testing the automation and sign off of new requirements for each release

Responsibilities For Energy Operations Compliance Senior Project Manager Resume

  • Identifies discrepancies or disconnects. Oversees consistent application of similar requirements. Works with State and Federal Compliance Managers to strategize and assist with the determination of viable solutions to benefit mandates
  • Provides subject matter expertise on compliance impact of projects and new product features, attending project calls, with an emphasis on the BST/PP tool and automation of compliance within that tool
  • Promotes a culture of compliance and ethical behavior
  • Assist in the collection and review of information requests for all internal and external audit inquires including those performed by: Corporate Audit, FINRA, PWC and State Departments of Insurance
  • Assist in the identification and development of key reporting metrics used throughout the Service Organization to measure and strengthen the overall compliance environment
  • Provide guidance to representatives and managers throughout the department on new and established regulatory and compliance guidelines
  • Track the status of outstanding information requests and distribute weekly and monthly communications to Service Organization management on current audit watch list items

Responsibilities For Compliance Senior Supervisor Resume

  • Summarize findings for further evaluation by management and assist in the development of action plans to address and prevent future occurrences. ‘
  • Creates and provides oversight of the testing and monitoring process on a continuing basis while taking appropriate steps to improve the overall effectiveness of the Compliance Program
  • Identifies potential areas of compliance vulnerability and risk; develops/implements corrective action plans for resolution of problematic issues, and provides general guidance on how to avoid or deal with similar situations in the future; and
  • Provides reports on a regular basis, and as directed or requested, to keep the senior management informed of the operation and progress of compliance efforts
  • Knowledge of voluntary/group insurance product rules and regulations
  • Demonstrated attention to detail, ability to compile and analyze regulatory and business information, determine cost-/benefit, and provide resolutions or recommendations for process improvement
  • Partners with the Compliance Manager and Senior Specialist to implement and maintain an effective compliance program for the organization, including promoting a culture of compliance and understanding of new and existing compliance issues and related policies and procedures

Responsibilities For UW & Product Compliance Senior Specialist Resume

  • Reviews all operational business policies to ensure they meet applicable state and federal legislation
  • Identifies potential areas of compliance vulnerability and risk; help develop/implement corrective action plans for resolution of problematic issues, and delivers general guidance on how to avoid or deal with similar situations in the future; and
  • Provides reports on a regular basis, and as directed or requested, to keep the Compliance management informed of the operation and progress of compliance efforts
  • Demonstrated attention to detail, ability to compile and present recommendations for process improvement
  • Highly collaborative individual with the ability to influence others and builds strong personal relationships
  • Nashville, TN Office location
  • At least, 2 - 4 years previous Medicare Advantage and Prescription Drug Planexperience, preferably with demonstrated skill in compliance auditing or QA processes
  • Provides meaningful and appropriate reporting metrics to support the Compliance Monitoring Program
  • Reports to the Part D Monitoring Manager within CHS’ Compliance Department

Responsibilities For Compliance Senior Mgr Resume

  • Monitors transactions for assigned Part D performance areas to confirm compliance with requirements
  • Provides subject matter expertise in response to day-to-day business issues related to coverage determinations
  • Collaborates with Compliance Medicare Business Support and Business Owners to drive process improvements and ensure that corrective action plans are tailored and appropriate for the deficiencies identified; and
  • Provides subject matter expertise in response to day-to-day business issues related to redeterminations
  • Answer insurance department objections and manage objections in accordance with established policies and procedures
  • Conduct day-to-day activities in accordance with compliance policies, procedures and standards of conduct
  • Reports to the Part C Clinical Compliance Manager in charge of monitoring Utilization Management, Appeals and SNP-MOC within the Compliance Department’s Part C & Service Operations Monitoring Unit
  • Monitors transactions for Utilization Management, with focus areas of Acute and Post-Acute admissions (e.g. inpatient hospital, SNF/Rehab), to confirm compliance with requirements

Responsibilities For BSA Compliance Senior Specialist Resume

  • Provides subject matter expertise in response to day-to-day business issues related to UM
  • Ensure compliance with Medicare reporting requirements and regulations pertaining to care plan and Interdisciplinary Care Team meetings as well as care management requirements
  • Document findings and work with case managers to determine the appropriate steps for remediation
  • Provide the GM and local Management Team members with strategic compliance support and advice on such matters as new projects/initiatives, launch planning and activities, Tone at the Top initiatives, and annual goals and business plans
  • Provide leadership, advice, guidance, direction and support to office and field based staff, and applicable third parties, on the interpretation and implementation of the local Code of Practice and Amgen healthcare compliance policies, procedures and practices

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