Description
GEHA (Government Employees Health Association, Inc., pronounced G. E. H. A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.
GEHA has one mission: To empower federal workers to be healthy and well.
Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.
Responsible for collaboration with all departments necessary to ensure that processes, programs, and services are accomplished in a timely and efficient manner in accordance with GEHA Plan benefit, OPM guidance and accreditation. Interacts with internal and external partners for oversight and governance of the compliance role.
**SKILLS**
**Duties and Responsibilities**
Monitoring a compliance program and communicating compliance information to leadership.
Reviewing and reporting on vendor performance tools.
Providing staff education and training on any changes to laws and regulations.
Monitoring and reporting for noncompliance issues.
Establishing best practices to support compliance.
Perform ongoing clinical and utilization data analysis for brochure changes.
Leads small scale projects with functional partners that support appropriate integration and application of benefit.
Serves as internal consultant to Medical Directors and staff on mandatory and recommended Plan Brochure changes, and subsequent related process changes.
Makes recommendations and ensures medical benefit policy is compliant with OPM directives and regulatory requirements.
Conducts work assignments of increasing complexity, under moderate supervision with some latitude for independent judgment.
Perform other duties as assigned.
**Required Knowledge, Skills, and Abilities**
Must possess the ability to build and maintain trust and productive relationships with internal stakeholders, clinicians, and others. Knowledge of CPT, HCPCS, and ICD-10 purpose and application within the payer industry.
Requires a bachelor's degree (or international equivalent) in a health care field (e. g., health care policy and clinical guidelines development, nursing, health care administration, compliance) and 4+ years of relevant experience. In lieu of education, additional years of experience will be considered.
Ability to perform effective research and critical analysis using evidenced based literature and medical compendium.
Ability to analyze and communicate findings from research including written summations of a specific medical technology in the areas of clinical effectiveness, measurable health outcomes, industry policy trends, and safety and appropriateness.
Career-development professional within field. Requires minimal skill set and proficiency in discipline.
Ability to work independently and collaboratively in a team-oriented environment.
**Preferred Knowledge, Skills, and Abilities:**
Project Management experience.
CPC Certification and/or supporting degree.
5+ years' experience in healthcare closely related field, or similar regulatory/ investigational roles in healthcare.
\#LI-Remote
Work-at-home requirements
Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.
A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.
Latency (ping) response time lower than 80 ms
Hotspots, satellite and wireless internet service is NOT allowed for this role.
A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
How we value you
Competitive pay/salary ranges
Incentive plan
Health/Vision/Dental benefits effective day one
401(k) retirement plan: company match - dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution
Robust employee well-being program
Paid Time Off
Personal Community Enrichment Time
Company-provided Basic Life and AD&D
Company-provided Short-Term & Long-Term Disability
Tuition Assistance Program
Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate's work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The annual base salary range for this position is $70,633 - $99,567 USD.
GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.
GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.
**Please note: Due to recent fraudulent activity in the job market, if you receive correspondence from someone at GEHA, we recommend you review the following facts to help verify if someone is truly a GEHA employee before sharing any personal information.**
All email addresses of GEHA employees will end with our domain,@ . Any other domain is not verified and is illegitimate. **Please double check the spelling as well** .
We will never extend a job offer without having at least one live video call.
We will never ask you for or provide you with any money, personal or banking information during the interview process or before signing an offer letter.
Please report any suspicious messages to HumanResources@ so that we can help reduce this fraudulent activity.
GEHA (Government Employees Health
Compensation Information:
$70633.0 / Yearly - $70633.0 / Yearly
Starting At: 70633.0 Yearly
Up To: 99567.0 Yearly
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