Compliance Specialist (Org Wide) (Home-Based)

Description

Join our award winning culture as we serve members in the state of Wisconsin!    

Under the general supervision of the Compliance Manager, the Compliance Specialist is responsible for operational support duties of the Compliance Department within the Compliance & Organizational Risk Division at Lakeland Care, Inc. (LCI). This role assists in maintaining LCI’s compliance program to ensure conformity and adherence with applicable federal, state, and local contracts, laws, and regulations. The Compliance Specialist provides standard operating procedure -driven operational and investigative support aligned with federal Program Integrity requirements, fraud/waste/abuse (FWA) intake, HIPAA Privacy, conflict-of-interest reporting oversight, and regulatory reporting. The role may include performing internal audits across the organization in accordance with the audit plans and departmental projects. 

Essential Competencies:

• Support program integrity reporting to State oversight entities, including suspected FWA referrals and overpayment or recoupment tracking.
• Support HIPAA incident intake, risk assessment, mitigation, and breach notification tracking.
• Conduct intake, triage, and track FWA allegations using standardized procedural criteria.  
• Establish individual and team projects to increase efficiency in compliance processes and implement measures to determine project effectiveness.  
• Perform inquiries and testing as needed to identify and resolve vulnerabilities discovered in audit processes.
• Recognize opportunities for process improvement and provide recommendations based on investigation results and audit monitoring.  
• Conduct audits, identify trends, and support corrective action development.
• Monitor and evaluate compliance reporting trends to identify potential risks and solutions.  
• Obtain, analyze, and evaluate internal documentation and data to identify risk within organizational systems. 
• Develop, conduct, and monitor new employee and annual employee compliance training.  
• Support the oversight of conflicts of interest for new hires and current staff through required annual disclosures and monitoring.  
• Conduct follow-up audits to monitor management-driven interventions and identify reportable issues and risks within internal systems. 
• Coach staff on ongoing Program Integrity, HIPPA, Civil Rights, and Conflict of Interest topics. 
• Encourage compliance-related learning/development by frequently providing updated and engaging training.
• Collaborate with internal and external stakeholders to maintain an environment supportive of reporting compliance concerns to continuously improve LCI’s compliance position.  
• Support colleagues in the Compliance & Organizational Risk Division by assisting with records requests, preparation of audits, regulatory submissions, and other support duties as requested. 
• Bolster workplace culture where all LCI staff prioritize legal and ethical conduct as a cornerstone to build and maintain member, colleagues, and external stakeholder trust in LCI. 
• Effectively interact internally and externally on necessary committees and bring forth ideas and solutions.  
• Develop and maintain audit plans to monitor organizational risk preparedness.

Requirements

• Bachelor’s degree in Business, Finance, Healthcare Administration, other related fields, or equivalent combination of education and experience (includes knowledge, skills, and abilities).    
• Compliance experience or healthcare experience preferred.  
• Thorough understanding of ethics, regulations, and laws.  
• Investigation and interview skills required. Knowledge of compliance ethics/control and forensic financial investigation preferred. 
• Knowledge of Program Integrity requirements specific to fraud, waste, and abuse. 
• Knowledge of HIPAA, state and federal guidelines on privacy, transactions, and security, electronic medical records, and releases of information. 
• Solid understanding of Civil Rights regulations and ability to comply. 
• Previous experience in development of policies and procedures preferred. 
• Ability to work and collaborate in a remote work environment across all departments and levels of management.  
• Proficiency with Microsoft 365, including Outlook, Microsoft Teams, SharePoint, OneDrive, Word, Excel, and PowerPoint.  
• Current driver’s license, acceptable driving record, and proof of adequate insurance required.  

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Lakeland Care is a Wisconsin-based non-profit organization that focuses on creating a world we all want to live in. With long-standing roots as a managed care organization (MCO), Lakeland Care provides long-term care services and supports to eligible frail elders and individuals with physical and intellectual or developmental disabilities through Wisconsin’s Family Care program. Currently we serve in 22 counties and have 11 offices in the Central to North East region of Wisconsin.

Our Mission

Empowering individuals. Strengthening communities. Inspiring futures.

Our Vision

To create a world we all want to live in.

Our Core Values

Kindness – We believe kindness is always possible and that no compassionate act is ever wasted.

Inclusion – We believe that open hearts and open minds are the only path to a brighter future.

Trust – We believe that honesty is still in style and that promises still have power.

We are an equal employment opportunity employer functioning under an Affirmative Action Plan. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law. We are an organization that participates in E-Verify.