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Company: Sentara Healthcare Inc
Location: New York
Posted on: May 16, 2022

Job Description:

This position acts as a Liaison between regulatory agencies and all internal departments to interpret and apply Medicaid contractual requirements to work processes. Support quality and integrity efforts for Government Programs. Assist with the interpretation of the Virginia Medicaid contract, laws, state, and federal regulationsThis position involves monitoring, tracking, trending, and reporting compliance with state, federal, and other regulatory requirements while managing and reducing compliance risks. Collaborates with the Manager of Program Administration to provide support and guidance in response to the changing needs of the organization, healthcare laws, and governmental policies. The Clinical Contract Admin will work with his/her manager to accomplish the following:

  • Develop, approve, and implement contractual changes through work plans, SOPs, policies, and procedures to achieve greater efficiencies and ensure alignment with regulations.
  • Develop and implement monitoring activities based on compliance requirements in the Medicaid contract and through internal auditing.
  • Manage the implementation of process changes, DMAS contract updates or new vendor contracts.
  • Analyze reports to monitor program and provider performance.
  • Perform audits, reviews, and monitoring to help ensure processes align with contractual standards and requirements.
  • Research regulatory issues and assist in the development of compliance solutions for new regulations.
  • Review data trends for Medicaid reports and capture results to ensure contractual requirements.
  • Develop and monitor controls of corrective action plans (CAPs) and violations to mitigate risk associated with control deficiencies identified.
  • Identify department breakdown/gaps and provide effective solutions to operational and technical issues.
  • Verify that all policies and procedures are documented appropriately, implemented, and communicated with the corporate mission and vision of the organization to ensure best practice.
  • Ensure contract requirements are implemented and complied with contract deliverables and corporate strategy.
    • Bachelor's Level Degree
      • Managed Care 5 years
        • Microsoft Excel
        • Microsoft PowerPoint
        • Microsoft Word

Keywords: Sentara Healthcare Inc, New York , COMPLIANCE ANALYST, Professions , New York, New York

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