Medicare Regulatory Compliance Specialist

Company: MetroPlus
Location: New York
Posted on: March 20, 2023

Job Description:

Empower. Unite. Care.MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.About NYC Health + HospitalsMetroPlusHealthprovides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealthnetwork includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealthhas been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.Position OverviewReporting to the Senior Manager of Medicare Regulatory Compliance, the Medicare Regulatory Compliance Specialist will support the oversight and management of the Medicare Compliance Program. The Specialist will support Medicare regulatory implementations and the correction and remediation of compliance issues. The Medicare Regulatory Compliance Specialist will assist in driving overall compliance with Medicare requirements. Job Description

• Supports the regular development and implementation of the Medicare Compliance Program including assistance with the development of the annual risk assessment and audit & monitoring workplan.
• Will assist in the development of Medicare related compliance training, ensuring its accuracy and consistency.
• Evaluating operational Medicare activities for compliance with applicable Medicare requirements.
• Contributes quality and timely data for the materials prepared for both the Internal Compliance Committee Meetings and Audit and Compliance Subcommittee of the Board of Directors.
• Oversees the implementation of regulatory directives. Includes synthesizing requirements into Compliance implementation activities, tracking related due dates and providing support to business areas completing deliverables.
• Upon identification of non-compliance, provide support to business areas in conducting a root cause analysis and corrective actions, including guidance on methodology, identification of relevant regulatory requirements and any regulatory compliance context, and compliance review, and plays a critical role in driving the progress for corrective actions throughout the organization.
• Coordinates the support for business areas in creating and updating monitoring metrics to assess continued compliance with regulatory requirements.
• Other duties as assigned or requested.Minimum Qualifications
  • Bachelor's degree required.
  • 3 years of experience in regulatory affairs / compliance required.
  • Experience in driving Corrective Action Plans (CAPs) and Process Improvement Plans (PIPs)
  • CHC, CCEP preferred.Professional Competencies
    • Experience with managed care, Medicare and federal regulations, quality improvement and compliance oversight
    • High-level of skill in leading interdepartmental and cross-functional strategy development; experience managing professional staff on multiple projects to ensure corporate deadlines and objectives are met. Simultaneously manage multiple projects
    • Excellent oral, written, and presentation skills, as well as conceptual and analytic skills are necessary in order to review and articulate corporate objectives and Federal regulations across all relevant audiences
    • The utmost integrity in the discreet and confidential handling of confidential materials is necessary

Keywords: MetroPlus, New York , Medicare Regulatory Compliance Specialist, Other , New York, New York