Description SUMMARY: The Compliance Document Specialist’s duties include creating and maintaining client’s Summary of Plan Descriptions (SPDs) as well as train and aid in the creation of Summary of Benefits and Coverages (SBCs). Oversight of the training for members of the organization’s workforce who have access to electronic protected health information (ePHI), dissemination of Compliance Policies and Procedures and oversight for a timely resumption of access to information in the event of a serious disruption.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- Create and maintain Summary Plan Descriptions (SPDs) to ensure they are comprehensive, accurate, and compliant with all regulatory requirements.
- Train and aid in the creation of Summary of Benefits and Coverages (SBCs), ensuring they meet ACA requirements and provide clear information to plan participants.
- Participate in all Implementation – Benefit Clarification Calls.
- Participate in implementations as requested.
- Monitor and interpret relevant regulations and provide guidance to ensure the Company's compliance with DOL, IRS, HHS, and state laws pertaining to self-funded group health plans.
- Respond to inquiries from clients and brokers regarding new and existing regulatory requirements impacting group health plans.
- Expected to engage in all applicable PHIA regulatory seminars & trainings; or any other offered trainings in order to stay current on plan compliance.
- Review and Company policies that detail compliance procedures for the administration of group health plans, focusing on the use and disclosure of individually identifiable participant data as defined by HIPAA and state privacy laws.
Supervisory Responsibilities: This job has no supervisory responsibilities.
Requirements
Knowledge, Skills, & Abilities:
- Strong computer skills, including Word, Excel, Outlook, and file database systems.
- Excellent written and verbal communication skills.
- Must be dependable and maintain excellent attendance and punctuality.
- Strong analytical skills and critical thinking skills.
- Ability to grow with changing demands of the position and the company.
- Ability to work in a team environment.
- Ability to learn and use specified and sequenced processes that require specific information and step-by-step execution.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience: High school or G.E.D. equivalent; and minimum of two years of increasingly responsible office administrative, specialized support in TPA/Self-funded environment and/or training; or equivalent combination of education and experience. Prior experience with data or document management, strong computer skills and a knowledge of relevant industry standards & regulations.
Language Skills: Ability to read, speak, and write effectively in English. Combination of soft and hard skills to create, manage, and maintain various types of documents, including technical manuals, user guides and policies. Key skills include communication, organization, attention to detail and the ability to work with subject matter experts. Also requires proficiency in relevant software like word processors and document management systems.
Mathematical Skills: Analytical thinking, attention to detail. Communication and problem-solving ability
Reasoning Ability: Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Certificates, Licenses, Registrations: N/A
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this Job, the employee is regularly required to sit for extended periods in front of a computer. The employee is frequently required to reach with hands and arms and talk or hear. The employee is occasionally required to stand; walk and use hands to finger, handle, or feel. The employee may frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus. This position requires the employee to work in the office.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate