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Position Purpose:  Manage the Dual compliance department functions, including but not limited to, regulatory and D-SNP contract review and interpretation, periodic monitoring and auditing activities based on established compliance program, policies, and practices to ensure and maintain compliance with federal, state, and local regulatory, contractual and legal requirements. As a Compliance Manager, you will be part of a fast-growing team who develops and maintains key relationships both internally with operational leaders as well as externally with our business partners, the State Medicaid Office and/or the Centers for Medicare and Medicaid Services (CMS). The Compliance Manager will work closely with Compliance Officer to optimize business results.

Key Responsibilities:

+ Manage approval and submission of timely and accurate D-SNP State Medicaid Agency (“SMAC”) contract and regulatory required report deliverables not limited to MMCM, CFR and state regulations.

+ Oversee all SMAC updates including creating new reporting needed.

+ Conduct periodic assessments to ensure compliance against SMAC and regulatory requirements.

+ O versee creation and implementation of corrective action plans to reduce or eliminate risk resulting from non-compliance with DSNP regulatory requirements or performance deficiencies.

+ Collaborate with AHCA, CMS and all internal teams where applicable, to maintain/improve regulator satisfaction specific to member/provider experience and compliance with regulatory requirements.

+ Manage composition and delivery of inquiries and responses to state regulatory agency about D-SNP inquiries. Submission may be done in collaboration with delegates and internal departments.

+ Actively engage in regulatory forums to include not limited to dedicated state meetings specific to the D-SNP.

+ Collaborate with internal departments and delegates to ensure responses address where appropriate the Duals plan from Medicaid specific requirements. Ensure responses align with D-SNP federal and state requirements as well as support Duals strategy.

+ Participate in new Duals business implementations, including the identification and tracking of required SMAC deliverables such as state reporting and requirements beyond D-SNP regulations or state specific program requirements applicable to the D-SNP.

+ Design, implement and improve processes to prevent, detect and respond to compliance issues and concerns related to all federal and state regulatory requirements and SMAC requirements.

+ Create and deliver Duals compliance training for all employees on an annual basis and as needed basis, such as in response to a compliance issue or concern.

+ Performs other duties as assigned.

+ Complies with all policies and standards.

+ Assist Compliance Officer with external regulatory audits acting as a liaison with external auditors and internal business constituents to gather responsive information.

+ Assists with developing, reviewing and updating Compliance policies

+ Assists in the development of the annual compliance risk assessment and work plan

+ Assists Compliance Officer and the business with preparing improvement and/or corrective action plans (CAPs) and root cause analysis and ensuring completion of the CAP by the business

+ Conducts Investigations, Audits, monitors activities and provides training and clarification of Medicare requirements and other general processes (includes delegates).

+ Reviews and assesses marketing material (and member communications) for compliance with the Medicare Marketing Guidelines and AHCA requirements.

+ Conducts research on compliance issues and relevant Medicare rules and other regulatory issues and provide appropriate guidance

+ Responsible for organizing, tracking and data entry of report(s), monitoring and auditing of submitted data including maintaining audit results and monthly reporting that tracks and compares compliance patterns.

+ Works closely with departments and/or delegated entities and communicates audit schedules and audit results to departments and/or the delegated entities.

+ Obtains, organizes and tracks internal information and delegated entities data report submissions for compliance purposes but not limited to tracking, trending, and communicating to assure data can be compared for trends and noncompliance.

+ Presents summary of all tracking reports to management, auditors, and other internal departments upon request, on a monthly basis and identifies areas of improvement.

+ Responsible for communicating effectively internally and with delegated entities with respect to notification of audit, including requesting of universes, communicating audit results and any follow-up Corrective Action Plan letter notifications.

+ Works with internal departments and delegation manager to maintain audit files in Inovaare including development documentation for oversight audits and corresponding data and assisting in preparation of audit files/cases for regulatory audits.

+ Other duties as assigned.

Qualifications:

+ Bachelor's Degree Health Care Administration, Compliance or related field or equivalent experience required

+ 5+ years Compliance including risk assessment against contract and regulatory requirements, creation and execution of auditing, monitoring and reporting processes, administration of correction action plans, implementation of written policies and procedures, developing and delivering compliance training and education required

+ Experience with D-SNP SMAC, regulatory requirements and/or operations required

+ Medicare managed health experience required

+ Business analytical skills: process flows, spreadsheets, modeling, procedures, etc.;

+ Strong knowledge of MS Office, including Access, Project, Excel, Visio;

+ Effective verbal and written communication skills; and ability to multi-task in a fast-paced, team-oriented environment.

Note:  This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s).  Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.

No Third Party Agencies or Submissions Will Be Accepted.

Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP

Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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