Healthfirst

The Business Relationship Specialist is responsible for promoting compliance with regulatory requirements within Healthfirst's Appeals and Grievances, and delegated vendor operations departments.

Job Description

• Supports regulatory and compliance activities of business unit’s Appeals and Grievances and related operations.
• Meets with the Regulatory department to organize deliverables and reviews materials.
• May interact and represents the Appeals and Grievance departments to internal auditors and coordinates responses to internal and external auditor requests.
• Identifies organizational risks and helps implement process improvements.
• Supports and participates in the implementation of contract changes for all lines of business pertaining to assigned Appeals and Grievances department. Ensures that all process and contract changes are reflected in departmental policies and procedures.
• Reviews Healthfirst policies, procedures, and job aids to ensure compliance with CMS and DOH regulations.
• Supports all Corrective Action Plans (CAPs) through completion.
• Reviews and conducts monitoring reports to assess for compliance with regulatory time frames and develops CAPs for same if out of compliance.
• Assists in regulatory audits, submissions, surveys, and internal audits.
• Additional duties as assigned.

Minimum Qualifications:

• Associates degree from an accredited institution
• Ability to work independently and to manage multiple tasks and responsibilities
• Strong communication skills, experience preparing and delivering information to multiple audiences
• Ability to work in a fast-paced environment
• Experience in managed care or the healthcare industry

Preferred Qualifications:

• BA or BS from an accredited institution
• Minimum of 1 year experience with healthcare compliance
• Experience creating and analyzing reports
• Excellent time and project management, communication, critical/creative thinking, and problem-solving skills
• Intermediate Outlook, Word, Excel, and PowerPoint skills including creating spreadsheets, pivot tables, queries, and formulas

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $67,200 - $97,155

• All Other Locations (within approved locations): $59,800 - $88,910

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.