Medicare Regulatory Compliance Specialist
New York, New York
Employer: NYC Health Hospitals
Industry: OFFICE CORPORATE COMPLIANCE
Salary: Competitive
Job type: Full-Time
MetroPlusHealth provides 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, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
Position Overview
Reporting 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
Minimum Qualifications
Professional Competencies
#LI-HYBRID
Position Overview
Reporting 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
- Provide implementation oversight by ensuring regulatory requirements have been effectively implemented by the internal and external business areas, including but not limited to:
- Synthesize regulatory guidance into Compliance activities.
- Track related due dates, updates and maintains Compliance Department trackers.
- Escalate items at risk for noncompliance.
- Ensure business area has implemented regulatory requirements by collecting documentation that demonstrate that the process, operations, trainings, policies, job aides have been updated, as applicable for a compliant close out.
- Conduct compliance reviews of operational policies and procedures to ensure adherence to regulatory and contractual obligations.
- Ensure proper investigation of all Medicare regulatory compliance related issues.
- Supports Compliance leadership in:
- External audits or regulatory requests as needed.
- Assisting in the development of the annual risk assessment and implementation of the annual work plan ensuring the gathering and provision of Medicare regulatory compliance related information.
- The regular development and review of Regulatory Compliance policies and procedures for the general operation of the Plan's compliance program and its' related activities for the Medicare line of business.
- Implementation of Compliance Work Plan activities.
- 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.
- Other duties as requested
Minimum Qualifications
- Bachelor's degree required.
- 4 years of managed care experience required, preferably in regulatory affairs/compliance.
- Experience with implementation of HPMS Memos, CMS Final Rules and Medicare Managed Manuals.
- Experience with operational implementation of Part C & D requirements and understanding operational workflows and processes.
- Experience in driving corrective action plans (CAPs) and compliance issue resolutions.
- CHC, CCEP Preferred
Professional Competencies
- Strong knowledge and experience with managed care, Medicare regulations/requirements, operational process improvement and compliance oversight.
- Ability to work independently and effectively.
- 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 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
#LI-HYBRID
Created: 2024-05-11
Reference: 106703
Country: United States
State: New York
City: New York
ZIP: 10036
Similar jobs:
-
Risk and Compliance Specialist, AWS Financial Services
Amazon in New York, New York💸 $118400 per year -
Global Sanctions Compliance Specialist
TikTok in New York, New York -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Staatsburg, New York💸 $84156 per year -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Babylon, New York💸 $84156 per year -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Jamesville, New York -
Compliance Specialist 1 (VID 157171)
StateJobsNY in Albany, New York -
Manager / Senior Manager, Compliance & Reporting Specialist
KPMG in Albany, New York💸 $88100 - $178700 per year -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Salamanca, New York -
Application Security Compliance Specialist - USDS (New York)
TikTok in New York, New York -
Virtual Currency Senior Internal Controls Specialist (Financial Services Specialist 2 (Compliance), SG-23)
StateJobsNY in NYC/Albany, New York -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in New York, New York💸 $84156 per year -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Trumansburg, New York -
Assisted Outpatient Treatment Compliance Specialist 1, Central Office;
StateJobsNY in Albany, New York -
Code Compliance Specialist 1 (NY HELPS)
StateJobsNY in Cheektowaga, New York -
Compliance Specialist 1
StateJobsNY in Albany, New York -
Virtual Currency Senior Analyst (Financial Services Specialist 2 (Compliance), SG-23)
StateJobsNY in New York/Albany, New York -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Saratoga Springs, New York -
AML Governance, Senior Compliance Specialist
SoFi in New York City, New York💸 $102400.00 per year -
Code Compliance Specialist 2 (NY HELPS)
StateJobsNY in Alexandria Bay, New York -
Virtual Currency Analyst (Financial Services Specialist 1 (Compliance), SG18)
StateJobsNY in New York/Albany, New York