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Job Description |
Medicaid Compliance Advisor
The candidate will analyze data, provide research services, and provide advice to minimize compliance risk exposure to the company. Will be part of a team who will develop and maintain key relationships both internally with company operational leaders as well as externally with the State Medicaid Officer, CMS and other regulators. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards. Define regulatory and contract requirements to be interpreted, monitored and audited by appropriate Departments. Coordinate and manage a standard set of information relating to regulatory standards. Perform assessments, develop action plans, and provide guidance to operations groups. Build relationships with responsible market contacts and external regulators. Serve as a translator between business leaders and State Medicaid Departments, assisting with the interpretation of the intention of the guidelines. Manage day to day interaction with outside regulators. Coordinate on-site audits, working with the regulators during their visits. Post site audits and negotiate findings to mitigate potential fines and sanctions. Provide oversight and monitor corrective action plan development. Meet established expectations and takes responsibility for achieving results; encourage others to do the same. Consistently model and inspire high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions. Effectively leverage resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Understand oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.
The candidate should have a Bachelor's degree or equivalent relevant experience. A J.D. degree is desired. Must have 5 years of experience in Health Plan Compliance. Advanced experience working in a Compliance related field is needed. Should have experience working with regulatory agencies, including state departments of health insurance and CMS. Must be knowledgeable in process improvement and metrics development. Should be knowledgeable in regulations governing health care industries. |
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