Compliance, Privacy, and Contract Manager

Job Overview

Description

• Solid interpersonal skills and ability to work collaboratively and lead effectively while influencing positive change.
• Strong organization skills, multitasking, and follow-through 
• Positive, energetic personality with ability to make quick, tough decisions
• Preference will be given to candidates with a legal background

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay) + additional annual Profit Sharing
• Flexible Paid Time Off Program (29 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc. 

• Develop and maintain processes, systems and explicit measures that ensure timely and accurate execution of compliance requirements.
• Lead and oversee all health plan compliance policies and procedures and assist in updating or developing new policies to improve operations, advance internal controls, or to meet new regulations/requirements.   
• Provide compliance review of federal, state, Center for Medicare and Medicaid Services (CMS) and Department of Insurance (DOI) requirements.
• Lead the Compliance team, establish annual objectives, provide ongoing feedback and support, create capacity plan, 
• Serve as a consultant to the health plan for compliance and regulatory questions and concerns.  Identify when an issue or question requires outside support or counsel.
• Coordinate with the Analytics Department on internal monitoring and auditing for policy compliance, discover preventive and corrective measures executed for audit findings and coordinate internal and external corrective measures to be executed. 

• Be informed of current legislation and enforcement issues affecting the healthcare industry, including but not limited to Medicare Cost Plan requirements, Commercial Health Plans, Clinical Quality, Pharmacy and PBMs, Accreditation, compliance best practices, and HIPAA.
• Work closely with departments for effective investigation, resolution, reporting, and remediation of compliance issues.  Prepare report for management on incidents, investigations, and all compliance issues and present at Compliance Committee meetings when appropriate. 
• Responsible for communication and coordination of issues requiring external counsel or external carrier support, guidance, or expertise.  Ensure appropriate external expertise is in place to cover the work being performed. 

• Maintain entity provider contract templates for MAHP in compliance with federal, state, CMS and DOI requirements as may be applicable. 
• Perform annual review and then as needed during the negotiation process.
• Develop and maintain contract oversight and checkoff process to assure proper review, signoff and management of entity contracts.
• Consult with health plan team related to contracts and contracting process.

Physical Aspects:

Reaching - Extending hand(s) and arm(s) in any direction.

Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles.

Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling.

Grasping - Applying pressure to an object with the fingers and palm.

Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly.

Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts.

Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers.

Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Environmental Conditions:
None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.

Please view Equal Employment Opportunity Posters provided by OFCCP https://www.eeoc.gov/poster