Under direction of the Director of Compliance and Regulatory Reporting, the primary focus areas of this position include the organization and day-to-day management of organization s policy and procedures process; entering guidance into the Commonwealth Care Alliance Regulatory Database; and conducting research on various regulations. This position will also be responsible for providing staff support to the P&P Committee which includes managing the annual review and approval process of CCA s policies and procedures. General Compliance Responsibilities: Maintain accurate CMS Audit Protocol universes, as required for compliance program effectiveness Check all workforce, contractors, vendors, and consultants against the applicable federal and state exclusions databases prior to hire or contract. Maintain accurate listing and appropriately escalate identified potential issues. Lead compliance specialist Provide first level review of vendor contracts to ensure appropriate required compliance documentation is in place. Conduct first review for potential FDR identified status. Conduct regulatory and contractual research as requested Manage the monthly automated OIG-LEIE, GSA (SAM), CMS Preclusion and Massachusetts Exclusion lists checks process Follow up on any potential matches identified during the monthly check process and work with appropriate internal departments Assist in development and delivering of compliance training content Maintain tracking and dashboard metrics of compliance training completion rates Work with business departments to identify areas for compliance monitoring Retain overall responsibility for managing all MassHealth Rate and OIG Notices. Process all MassHealth Rate and OIG notifications. Create summaries of changes to requirements and regulations, and independently identify business owners, impacted departments and required next steps for implementation. Coordinate internal Rate Group to promote prompt implementation of rate changes. Review, analyze and distribute Annual OIG Workplan Development of metrics and reporting to demonstrate effectiveness of CCA s Compliance Program In collaboration with the Senior Compliance Specialist, identify, develop and product metrics to demonstrate effectiveness of CCA s Compliance Program. Work collaboratively with all divisions within Regulatory Affairs and Compliance Department Oversee and manage processes that generate Compliance data to ensure compliance data meets all requirements for applicable transparency laws and regulations governing the industry Prepare metrics and reports for consumption by different levels within the organization. Review certain issue notifications/disclosures and assign compliance risk level. Work collaboratively with impacted departments to identify root cause and make recommendations for corrective actions, as identified. Policy and Procedures: Maintain and update department policies and procedures as necessary to reflect changes in federal and state laws and regulations Provide guidance and assistance in the development of policies and procedures to ensure policies and procedures are carried through the draft, audit, review and approval processes Support Policy and Procedure Committee workflow, including: working directly with CCA staff to update applicable policies and procedures; coordinating committee meetings; conducting trainings with CCA staff on the policy and procedure creation, update and retirement processes Compliance Review: Provide compliance review of marketing materials prior to submission to CMS and/or MassHealth Provide internal compliance review of member facing materials Review and analyze state and federal regulations and requirements: Assist in processing regulatory guidance, including but not limited to, HPMS Memoranda, Federal Register, and/or OIG notifications and other regulatory guidance. Create summaries of changes to requirements and regulations, and identify business owners, impacted departments and required next steps for implementation. Coordinate distribution, comment collection and submission process for updated regulations Secondary Responsibilities: Support overall Regulatory and Compliance Infrastructure Work with Compliance Specialist -Training to review and evaluate training documentation and needs of the organization. Monitor training completion metrics. Serve as Regulatory Affairs and Compliance liaison with key internal departments Provide guidance and assistance as requested Hold meetings with department leadership at agreed upon intervals Attend department staff meetings and present information as requested Assist in development of regulatory tool-kits and instruction materials as needed to assist departments with regulatory projects and process implementation Support business units in interpretation of regulations related to their applicable areas as well as provide assistance in developing appropriate tools to ensure compliance Provide consultation with business owners in developing policies and procedures and/or building internal workflows to ensure internal controls of high risk regulatory requirements are in place and working effectively Assist with maintenance of GRC system Identify needed enhancements and work with vendor to manage enhancement requests Test enhancements to ensure they are functioning as expected Take lead role in running dashboard/leadership/management reports Prepare and coordinate regulatory filings as required Work with business owners to develop reporting playbooks to support CCA s regulatory and contractual reporting requirements. Assist in the coordination of communications, data collection, organization and submission of materials for external reviews and audit requests, as required Assist in the oversight of the corporate Compliance Plan and identification of compliance risks Assist in maintaining an effective compliance plan at CCA by promoting compliance with all compliance plan elements Develop new processes and/or programs as directed Build subject matter expertise in identified operational areas of the business implementation. The combination of tasks or functional activities in this role requires the job holder to plan and organize their own time and to know how their work relates to the work of others. Latitude is permitted, because of changing work circumstances, to consider the most appropriate procedure or precedent to follow. Beginner to intermediate level of complexity. Most often, the job holder will encounter similar situations requiring solution by the discriminating choice between known alternatives. At times, the situation to be resolved includes circumstance, facts and issues that are different from those that have been encountered in the past. The job holder is expected to consider alternative courses and make a recommendation to the supervisor on how to proceed. Bachelor s degree or equivalent work experience is required. Regulatory compliance experience preferred; health care compliance programs experience strongly preferred. 1-2 years work experience in health care strongly preferred. Project management skills - having the ability to effectively manage multiple priorities simultaneously by maintaining established timeframes, adhering to work plans and communicating changes effectively, demonstrate attention to detail. Strong written, verbal, listening and communication skills having the ability to understand and communicate appropriately to the targeted audience. Must be able to effectively communicate with colleagues, internal customers and vendors. Data analytical skills. Strong analytical skills having the ability to identify an issue, conduct an analysis to determine business impact (including gap analysis), troubleshoot and identify solutions. Candidate must be able to prioritize work and use independent judgment. Self-directed with proven initiation skills. Ability to initiate and develop new solutions to problems, to identify new opportunities; and have organizational perspective to see how the pieces fit and reflect that perspective in day-to-day decisions. A background with Medicare, Medicaid and/or health plan operations is preferred. Experience with health care compliance programs is also preferred. English fluency. General office equipment; computers, telephones, copy machines, scanners, faxes. Position requires constant operation of a computer and other office equipment (i.e., copy machine, Polycom equipment, and computer printer) Must be able to remain in a stationary position 50 percent of the time Must be able to travel locally to CCA/CCC offices and conferences via public transportation and/or personal vehicle, as needed. Must be able to effectively communicate with colleagues, internal customers and vendors Associated topics: attorney corporate, business, compliance, compliance department, compliance office, corporate attorney, lawyer, legal, legal department, market
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.